Private Health Insurance (Prostheses) Rules 2015 (No. 1) (Cth)
made under item 4 of the table in section 333-20 of the
Includes amendments up to: Private Health Insurance (Prostheses) Amendment Rules 2015 (No. 2)
This is a compilation of the
This compilation was prepared on 3 August 2015.
The notes at the end of this compilation (the
The effect of uncommenced amendments is not reflected in the text of the compiled law but the text of the amendments is included in the endnotes.
If the operation of a provision or amendment is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
If a provision or the compiled law is affected by a modification that is in force, details are included in the endnotes.
If a provision of the compiled law has expired or otherwise ceased to have effect in accordance with a provision of the law, details are included in the endnotes.
1. Name of Rules These Rules are the
Private Health Insurance (Prostheses) Rules 20 15 (No. 1) .
(1) These Rules commence on 18 March 2015.
(2) These Rules are made under item 4 of the table in section 333-20 of the
Private Health Insurance Act 2007 .
These Rules revoke the
Private Health Insurance (Prostheses) Rules 2014 (No. 2) .
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.
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.
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 in 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 in 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 in 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
(b) the maximum benefit is the amount for that prosthesis listed in the column under the heading 'Minimum Benefit' in the Schedule.
(4) For a gap permitted prosthesis provided as part of an episode of hospital treatment in 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
(b) 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 subsection 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.
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.
Note 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.
Note 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.
The following endnotes are included in each compilation:
Endnote 1 – About the endnotes
Endnote 2 – Abbreviation key
Endnote 3 – Legislation history
Endnote 4 – Amendment history
Endnote 5 – Uncommenced amendments
Endnote 6 – Modifications
Endnote 7 – Misdescribed amendments
Endnote 8 – Miscellaneous
If there is no information under a particular endnote, the word “none” will appear in square brackers after the endnote heading.
The abbreviation key in this endnote sets out abbreviations that may be used in the endnotes.
Amending laws are annotated in the legislation history and amendment history.
The information includes commencement information for amending laws and details of application, saving or transitional provisions that are not included in this compilation.
It also includes information about any provision s that have expired or otherwise ceased to have effect in accordance with a provision of the compiled law.
The effect of uncommenced amendments is not reflected in the text of the compiled law, but the text of the amendment is included in endnote 5.
If the compiled law is affected by a modification that is in force, details of the modification are included in endnote 6.
Any misdescribed amendment is included in Endnote 7.
Endnote 8 includes any additional information that may be helpful for a reader of the compilation.
ad = added or inserted am = amended c = clause(s) CH = Chapter(s) def = definition(s) Dict = dictionary disallowed = disallowed by Parliament Div = Division(s) exp = expired or ceased to have effect hdg = heading(s) LI = legislative instruments LIA = mod = modified/modification No = Number(s) o = orders Ord = Ordinance orig = original par = paragraph(s)/subparagraphs(s) /sub‑subparagraph(s) | pres = present prev = previous (prev) = previously Pt = Part(s) r = regulation(s)/rule(s) Reg = Regulation/Regulations reloc = relocated renum = renumbered rep = repealed rs = repealed and substituted s = section(s) Sch = Schedule(s) Sdiv = Subdivisions(s) SLI = Select Legislative Instrument SR = Statutory Rules Sub-Ch = Sub-Chapter(s) SubPt = Subpart(s) |
2 March 2015 F2015L00241 | 18 March 2015 | ||
15 April 2015 F2015L00540 | 1 May 2015 | - | |
6 July 2015 F2015L01111 | 10 July 2015 | - |
This endnote sets out the amendment history of the
ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted
am. F2015L00540 | |
am. F2015L01111 |
There are no uncommenced amendments
There are no modifications.
There are no misdescribed amendments.
Part A - Prostheses List February 2015
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
AO019 Verisyse AC IOL Aphakic Model 5mm Optic Diameter x 8.5 $250.00
overall length
EG009 Artisan Anterior Chamber Aphakia ModelComposition: PMMA 5.00mm Optic Diameter x $250.00
Intraocular Lens 8.5 in 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 1092
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
EG019 Artisan Toric (Custom) T1 AC Iris clip IOL Toric 5.00mm Optic Diameter x $1,150.00
7.5 Overall
AO029 Verisyse Toric (Custom) Phakic intraocular lens: Model toric 5mm Optic Diameter x $1,358.00
7.5mm overall length
EG020 Artisan Toric (Custom) T2 AC Iris clip IOL Toric 5.00mm Optic Diameter x $1,452.00
7.5 Overall
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
Prostheses List by Category, Groups and Sponsor Page 2 of 1092
AL002 Models MZ60BD, MC50BD, CZ70BD Other:PMMA Range of Powers:-10 to +34 $156.00
D
CZ040 CT SPHERIS 209M Micro incision, aspheric (aberration Diopter range :0.00 to + $322.00
correcting), foldable square-edged 32.0. Optic Size: 6mm
single-piece intraocular lens for Overall Length: 11mm
capsular bag fixation.
CZ016 CT ASPHINA 409M ZEISS Micro Incision Aspheric 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 control, (22.50-30D)
Prostheses List by Category, Groups and Sponsor Page 3 of 1092
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 intraocular 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
DV263 Rayner C-flex Advance Aspheric Mini incision pre-loaded aspheric IOL Power range +8.0 - +34.0 $374.00
dioptres in 0.5 increments
EG016 ARTIS PL E Preloaded Intraocular lens 0 to 35D $374.00
EG017 LUXIOL 60 Preloaded Intraocular lens +10 to +35D $374.00
IS013 Preloaded Monofocal Hydrophilic Posterior chamber IOL, 360° Special Optic diameter: 6.0 mm $374.00
677P without Blue light Filter for Square Edge, Aspheric – Coma ±0.10 mm,
Medjet PL-MA 2.2 single use optimized Overall diameter: 13.0 mm
injection system ±0.20 mm
Powers available:
1.0 D
0.5 D
0.5 D
+31.0 - +45.0 D ±0. D
1.0 D
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
EG015 ARTIS T PL Preloaded Toric Intraocular lens +18 to +25D / C +1.50D $760.00
Prostheses List by Category, Groups and Sponsor Page 4 of 1092
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
IS017 Preloaded Monofocal Hydrophilic Posterior chamber IOL, 360° Special Optic diameter: 6.0 mm $405.00
677PY with Blue light Filter for Square Edge, Aspheric – Coma ±0.10 mm, Overall diameter:
Medjet PL-MA 2.2 single use optimized 13.0 mm ±0.20 mm
injection system Powers available:
-10.0 - +9.0 D ±0.25 D
1.0 D
+10.0 - +25.0 D ±0.25 D
0.5 D
+25.5 - +30.0 D ±0.5 D
0.5 D
+31.0 - +45.0 D ±0.5
1.0 D
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
Prostheses List by Category, Groups and Sponsor Page 5 of 1092
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
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 Range available from -10D $322.00
Sensar OptiEdge AR40e Absorbing, Posterior to +30D. 6 mm Optic
Foldable Acrylic IOL Diameter x 13mm in overall
length.
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 6 of 1092
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 to +34 diopter powers in $364.00
modification and 360 degree square 0.5d increments. Overall
edge diameter 13mm, Optic size
6mm
BL022 SofPort Advanced Optic (AO) Posterior chamber, foldable silicone 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 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 from +0.0 to +34D
an aspheric lens optic, square 0.0D to 10.0D in 1 Diopter
posterior edge, modified C haptics and increments
available in dioptric powers ranging 11.0D to 30.0D in 0.5
from +0.0 to +34.0D. Diopter increments
31.0D to 34.0D in 1
Diopter increments
Prostheses List by Category, Groups and Sponsor Page 7 of 1092
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.
IS010 BiFlex 677AB Hydrophilic Acrylic Posterior chamber IOL, 360° Special Optic diameter: 6.0 mm $364.00
Foldable Aspheric Monofocal Lens Square Edge, Aspheric – Coma ±0.10 mm, Overall diameter:
(without Blue light Filter) optimized 13.0 mm ±0.20 mm
Powers available:
-10.0 - +9.0 D ±0.25 D
1.0 D
+10.0 - +25.0 D ±0.25 D
0.5 D
+25.5 - +30.0 D ±0.5 D
0.5 D
+31.0 - +45.0 D ±0. D
1.0 D
Prostheses List by Category, Groups and Sponsor Page 8 of 1092
IS015 BiFlex 877FAB Hydrophobic Posterior Chamber IOL, special 360° Optic diameter: 6.0 mm $364.00
Acrylic Foldable Aspheric sharp edge, Aspheric - "Aberration ±0.10 mm, Overall diameter:
Monofocal Lens without Blue light Balanced" 13.0 mm ±0.20 mm
Powers available:
-0.0-+9.0 D ± 0.25 D
increment: 1.0 D
+10.0-+ 25.0 D ± 0.25 D
increment: 0.5 D
+25.5-+ 30.0 D ± 0.5 D
increment: 0.5 D
+31.0 - +35.0 D ±0.5 D
increment: 1.0 D
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
IQ013 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
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
SO074 HumanOptics Aspira Posterior chamber IOL, foldable, UV -6.0 to +40.0 D $364.00
absorber, Aspheric, aberration
technology, 360° LEC barrier, HD
Prostheses List by Category, Groups and Sponsor Page 9 of 1092
AO034 TECNIS® iTec 1-Piece Pre-Loaded 1-piece IOL Posterior Chamber +5.0 to +34.0 diopter $374.00
IOL 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
IQ014 PreciSAL P302AC Preloaded Acrylic, single piece, Available in dioptric $374.00
foldable intraocular lens with anterior powers from 0.0 to +30.0.
and posterior optic-haptic square 1D steps: 0.0 to +10.0;
edge, 360 degree optic square edge 0.5D steps: +10.5 to + 17.5
design, precision power calculation, and +28.5 to +30.0; 0.25D
aberration technology and UV light steps: +18.0 to +28.0
SO075 HumanOptics Aspira Preloaded Preloaded posterior chamber IOL, +10.0 to +40.0 D $374.00
foldable, UV absorber, Aspheric,
aberration technology, 360° LEC
barrier, HD optic
BL032 enVista Toric The enVista toric (Model MX60T) is a Overall diameter is 12.5mm $760.00
one-piece glistening-free for the entire lens power
hydrophobic foldable IOL. The range, with spherical
enVista Toric, model MX60T IOL has equivalent powers from +6.0
a Toric aspheric lens optic, a square to +30.0 Diopters in 0.5
posterior edge and modified C haptics, Diopter steps and cylinder
an 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.
Prostheses List by Category, Groups and Sponsor Page 10 of 1092
IQ017 PreciSAL Toric T302AC Acrylic single piece, foldable Available in spherical $760.00
intraocular lens with anterior and dioptric powers from 0.0 to
posterior optic-haptic square edge, +30.0. 1D steps: 0.0 to
360 degree optic square edge design, +10.0; 0.5D steps: +10.5 to
precision power calculation, +17.5 and +28.5 to +30.0;
aberration technology, toric 0.25D steps: +18.0 to
correction on anterior surface with +28.0; Cylinder powers
cylinder marks to indicate flat from 1.0D to 6.0D
meridian plus the cylinder axis to
allow alignment for astigmatic
correction, and UV filter.
IQ018 PreciSAL Toric PT302AC Pre-loaded acrylic single piece, Available in spherical $760.00
foldable intraocular lens with anterior dioptric powers from 0.0 to
and posterior optic-haptic square +30.0. 1D steps: 0.0 to
edge, 360 degree optic square edge +10.0; 0.5D steps: +10.5 to
design, precision power calculation, +17.5 and +28.5 to +30.0;
aberration technology, toric 0.25D steps: +18.0 to
correction on anterior surface with +28.0; Cylinder powers
cylinder marks to indicate flat from 1.0D to 6.0D
meridian plus the cylinder axis to
allow alignment for astigmatic
correction, and UV filter.
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 11 of 1092
BL035 MICRO+ AY 123 Preloaded, posterior chamber, UV An overall diameter of $405.00
absorbing, foldable, aspheric, acrylic, 10.75mm and optic diamter
single piece lens with blue light of 6.15mm. From 0 to +35
protection. diopters with 0.5 diopter
increments.
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
DV262 Hoya 751 Intra Ocular Lens Intra Ocular Lens Power +10 dioptres - +26 $405.00
dioptres
IQ016 PreciSAL P302A Preloaded Acrylic, single piece, Available in dioptric $405.00
foldable intraocular lens with anterior powers from 0.0 to +30.0.
and posterior optic-haptic square 1D steps: 0.0 to +10.0;
edge, 360 degree optic square edge 0.5D steps: +10.5 to +17.5
design, precision power calculation, and +28.5 to +30.0; 0.25D
aberration technology and blue light steps: +18.0 to +28.0
VI001 Nidek SZ-1 Pre-Loaded IOL Pre-Loaded Intra Ocular Lens Power +11 dioptres to 30+ $405.00
Injector System Implantation system dioptres
SO067 HumanOptics Aspira Y Preloaded Preloaded posterior chamber IOL, +10.0 to +30.0 D $405.00
foldable, UV absorber, Aspheric,
aberration technology, 360° LEC
barrier, HD optic, Blue light filter
SO071 Mediphacos Easyflex Preloaded posterior chamber IOL, +5.0 to +30.0 D $405.00
foldable, UV absorber, Aspheric,
aberration technology, double square
edge, Blue light filter
Prostheses List by Category, Groups and Sponsor Page 12 of 1092
AO039 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, 3.75 diopter, 4.00
of the optic has a frosted design to diopter, 4.50 diopter, 5.25
reduce potential edge glare effects. diopter and 6.00 diopter (as
measured at the IOL plane).
Overall diameter 13mm,
Optic size 6mm.
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)
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)
SO060 HumanOptics Torica Toric posterior chamber IOL, foldable, Sphere +10D to +30D, $740.00
UV absorber, Aspheric, aberration Cylinder 1D to 6D
technology, 360° LEC barrier, HD
Prostheses List by Category, Groups and Sponsor Page 13 of 1092
IQ020 PreciSAL Toric PT302A Pre-loaded acrylic single piece, Available in spherical $800.00
foldable intraocular lens with anterior dioptric powers from 0.0 to
and posterior optic-haptic square +30.0. 1D steps: 0.0 to
edge, 360 degree optic square edge +10.0; 0.5D steps: +10.5 to
design, precision power calculation, +17.5 and +28.5 to +30.0;
aberration technology, toric 0.25D steps: +18.0 to
correction on anterior surface with +28.0; Cylinder powers
cylinder marks to indicate flat from 1.0D to 6.0D
meridian plus the cylinder axis to
allow alignment for astigmatic
correction, and UV and blue light
filters.
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)
IS012 Medicontur BiFlex 677TAY Posterior chamber IOL, 360° Special Optic diameter: 6.0 mm $780.00
Hydrophilic Acrylic Foldable Toric Square Edge, ±0.05 mm, Overall diameter:
Lens with Blue light Filter Aspheric – Coma optimized – Toric 13.0 mm ±0.10 mm
Powers available:
-10.0 - +30.0 D ±0.25 D
increment: 0.5 D
- +35.0 D ±0.5 D
1.0 D
+1.5 D - +9.0 D
0.75 D
+9.0 D - +10.0 D
1.0 D
Prostheses List by Category, Groups and Sponsor Page 14 of 1092
IQ019 PreciSAL Toric T302A Acrylic single piece, foldable Available in spherical $780.00
intraocular lens with anterior and dioptric powers from 0.0 to
posterior optic-haptic square edge, +30.0. 1D steps: 0.0 to
360 degree optic square edge design, +10.0; 0.5D steps: +10.5 to
precision power calculation, +17.5 and +28.5 to +30.0;
aberration technology, toric 0.25D steps: +18.0 to
correction on anterior surface with +28.0; Cylinder powers
cylinder marks to indicate flat from 1.0D to 6.0D
meridian plus the cylinder axis to
allow alignment for astigmatic
correction, and UV and blue light
filters.
SO057 HumanOptics Torica Y Toric posterior chamber IOL, foldable, Sphere +10D to +30D, $780.00
UV absorber, Aspheric, aberration Cylinder 1D to 6D
technology, 360° LEC barrier, HD
optic, Blue light filter
SO072 Mediphacos Miniflex Toric Toric posterior chamber IOL, foldable, Sphere +5.0 to +30.0 D, $780.00
UV absorber, Aspheric, aberration Cylinder < 7D
technology, double square edge, Blue
light filter
AO040 TECNIS® Toric 1-Piece IOL 1-piece IOL Posterior chamber +5.0 to +34.0 diopter $1,042.00
Intraocular lens, incorporates a powers in 0.5 diopter
proprietary wavefront designed toric increments. Cylinder
aspheric optic with a squared power: 7.00 diopter, 8.00
posterior optic edge designed to diopter (as measured at the
provide a 360 degree barrier. The edge IOL plane). Overall
of the optic has a frosted design to diameter 13mm, Optic size
reduce potential edge glare effects.
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)
Prostheses List by Category, Groups and Sponsor Page 15 of 1092
SO059 HumanOptics Torica Toric posterior chamber IOL, foldable, Sphere +10D to +30D, $1,042.00
UV absorber, Aspheric, aberration Cylinder 7D to 12D
technology, 360° LEC barrier, HD
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.
SO058 HumanOptics Torica Y Toric posterior chamber IOL, foldable, Sphere +10D to +30D, $1,084.00
UV absorber, Aspheric, aberration Cylinder 7D to 12D
technology, 360° LEC barrier, HD
optic, Blue light filter
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
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).
Prostheses List by Category, Groups and Sponsor Page 16 of 1092
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).
IS014 BiFlex 877FABY Hydrophobic Posterior Chamber IOL, special 360° Optic diameter: 6.0 mm $385.00
Acrylic Foldable Aspheric sharp edge, Aspheric - "Aberration ±0.10 mm, Overall diameter:
Monofocal Lens with Blue light Balanced" 13.0 mm ±0.20 mm
Powers available:
-0.0-+9.0 D ±0.25 D
increment: 1.0 D
+10.0 - +25.0 D ±0.25 D
increment: 0.5 D
+25.5- +30.0 D ±0.5 D
increment: 0.5 D
+31.0- +35.0 D ±0.5 D
increment: 1.0 D
IS016 BiFlex 677ABY Hydrophilic Posterior chamber IOL, 360° Special Optic diameter: 6.0 mm $385.00
Acrylic Foldable Aspheric Square Edge, Aspheric – Coma ±0.10 mm, Overall diameter:
Monofocal Lens with Blue light optimized 13.0 mm ±0.20 mm
Powers available:
-10.0 - +9.0 D ±0.25 D
1.0 D
+10.0 - +25.0 D ±0.25 D
0.5 D
+25.5 - +30.0 D ±0.5 D
0.5 D
+31.0 - +45.0 D ±0. D
1.0 D
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
Prostheses List by Category, Groups and Sponsor Page 17 of 1092
IQ015 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
SO055 HumanOptics Aspira Y Posterior chamber IOL, foldable, UV -6.0 to +40.0 D $385.00
absorber, Aspheric, aberration
technology, 360° LEC barrier, HD
optic, Blue light filter
SO073 Mediphacos Miniflex/Mediflex Posterior chamber IOL, foldable, UV +5.0 to +30.0 D $385.00
absorber, Aspheric, aberration
technology, double square edge, Blue
light filter
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
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)
Prostheses List by Category, Groups and Sponsor Page 18 of 1092
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
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
steps
+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
AO026 TECNIS® Multifocal Intraocular Posterior chamber lens with UV light- +5 to +34 diopter powers in $822.00
Lens (ZMA00) absorbing, foldable acrylic, 3-piece 0.5d increments. Overall
with a diffractive posterior optic and a diameter 13mm, Optic size
modified anterior surface technology 6mm
with edge modification and 360
degree square edge.
Prostheses List by Category, Groups and Sponsor Page 19 of 1092
AO027 TECNIS® Multifocal 1-Piece Lens, A multifocal posterior chamber lens 6.0mm Optic Diameter x $822.00
Models ZMB00, ZKB00, ZLB00 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. ZMB00 +4.00
and a 360 degree square edge. Diopter add, ZKB00 +2.75
add,
AO037 TECNIS® Symfony Extended Range Extended Range of Vision Posterior +5.0 to 34.0 diopter powers $822.00
of Vision (ZXR00) Chamber IOL in 0.5 diopter increments
Overall diamter 13mm,
Optic size 6mm
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.
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)
IQ023 PreciSAL Multifocal M302AC Acrylic single piece, foldable Available in spherical $822.00
intraocular lens with anterior and dioptric powers from 0.0D
posterior optic-haptic edge, 360 to +30.0D. 1D steps: 0.0D
degree optic square edge design, to+10.0D; 0.5D steps:
precision power calculation, +10.5 to +17.5 and +28.5 to
abreration technology, pupil +30.0; 0.25D steps: +18.0
independent diffractive anterior to +28.0; near sight
surface with a near sigh correction correction addition up to
addition of up to +3.5D, and UV +3.5D on all spherical
Filter. dioptric powers.
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
Prostheses List by Category, Groups and Sponsor Page 20 of 1092
SO063 HumanOptics Diffractiva Multifocal posterior chamber IOL, Sphere: +10D to +30D, $822.00
foldable, UV absorber, Aspheric, Near addition +3.5D
aberration technology, 360° LEC
barrier, HD optic
AO036 TECNIS® Multifocal 1-Piece IOL Preloaded 1-Piece Multifocal +5.0 to 34.0 diopter powers $842.00
with iTec Preloaded delivery system posterior chamger IOL in 0.5 diopter increments
Overall diamter 13mm,
Optic size 6mm
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.
IQ024 PreciSAL Mulitfocal PM302AC Pre-loaded acrylic single piece, Available in spherical $842.00
foldable intraocular lens with anterior dioptric powers from 0.0 to
and posterior optichaptic square +30.0. 1D steps: 0.0 to
edge, 360 degree optic square edge +10.0; 0.5D steps: +10.5 to
design, precision power calculation, +17.5 and +28.5 to +30.0;
aberration technology, pupil 0.25D steps: +18.0 to
independent diffractive anterior +28.0; near sight correction
surface with a near sight correction addition up to +3.5D on all
addition of up to +3.5D, and UV filter. spherical dioptric powers.
Prostheses List by Category, Groups and Sponsor Page 21 of 1092
SO065 HumanOptics Diffractiva Preloaded Preloaded Multifocal posterior Sphere: +10D to +30D, $842.00
chamber IOL, foldable, UV absorber, Near addition +3.5D
Aspheric, aberration technology,
360° LEC barrier, HD optic
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
CZ036 AT LISA tri Toric 939MP Trifocal (aspheric), bitoric, micro Diopter range -10.00 to $1,218.00
incision, single-piece IOL for +28.0 and +1 to +4.0 DC
capsular bag fixation, implantable Optic size: 6..00mml;
with preloaded injector system. The Overall length: 11.mm
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,
IQ025 PreciSAL Multifocal PM302A Pre-loaded acrylic single piece, Available in spherical $884.00
foldable intraocular lens with anterior dioptric powers from 0.0 to
and posterior optichaptic square +30.0. 1D steps: 0.0 to
edge, 360 degree optic square edge +10.0; 0.5D steps: +10.5 to
design, precision power calculation, +17.5 and +28.5 to +30.0;
aberration technology, pupil 0.25D steps: +18.0 to
independent diffractive anterior +28.0; near sight correction
surface with a near sight correction addition up to +3.5D on all
addition of up to +3.5D, and UV and spherical dioptric powers.
blue filter powers.
SO066 HumanOptics Diffractiva Y Preloaded Multifocal posterior Sphere: +10D to +30D, $884.00
chamber IOL, foldable, UV absorber, Near addition +3.5D
Aspheric, aberration technology,
360° LEC barrier, HD optic, Blue
Prostheses List by Category, Groups and Sponsor Page 22 of 1092
AO033 TECNIS® Multifocal Toric Toric Multifocal Intraocular Lens Available +5.0 Diopters to $1,198.00
+34.0 Diopters in 0.5
Cylinder powers 1.50D,
2.25D, 3.00D and 4.00D (as
measured on the IOL
AO038 TECNIS Symfony Toric Extended Extended Range of Vision Toric +6 to +30 in 0.5d steps $1,198.00
Range of Vision (ZXT00) Multifocal Posterior Chamber IOL Available Cyl powers
+1.0d, 1.5d, 2.25d, 3.00d,
CZ038 AT LISA tri toric 939M low cylinder Trifocal (aspheric), bitoric, micro Diopter range: -10.00 to + $1,198.00
incision, single-piece IOL for 32.0 DS and +1 to +6.5DC
The trifocal Optic Size: 6.0mm. Overall
(anterior) optic provides two Length: 11.0mm
diffractive focal points (+3.33D near
focus and +1.66D intermediate focus)
with asymmetric light distribution
50% distance / 20% intermediate /
30% near vision.
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
BL036 FineVision Toric POD FT Posterior chamber, toric, trifocal An overall diameter of $1,240.00
diffractive (aspheric), UV and blue 11.40mm and optic diameter
light blocker, single piece acrylic of 6.00mm. From 0 to +35
Diopters with 0.5 diopter
increments.
Prostheses List by Category, Groups and Sponsor Page 23 of 1092
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.
CZ039 AT LISA tri toric 939M high Trifocal (aspheric), bitoric, micro Diopter range: -10.00 to + $1,500.00
powered cylinder incision, single-piece IOL for 32.0 DS and +7 to +12 DC
capsular bag fixation. The trifocal Optic Size: 6.0mm. Overall
(anterior) optic provides two Length: 11.0mm
diffractive focal points (+3.33D near
focus and +1.66D intermediate focus)
with asymmetric light distribution
50% distance / 20% intermediate /
30% near vision.
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.
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
Prostheses List by Category, Groups and Sponsor Page 24 of 1092
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
BL033 FineVision POD F Posterior chamber, UV absorbing, An overall diameter of $864.00
foldable, aspheric, acrylic, single 11.40mm and optic diameter
piece lens with apodised diffractive, of 6.00mm. From 0 to +35
trifocal optic and blue light diopters with 0.5 diopters
with 0.5 diopter increments.
BL034 FineVision Micro F Posterior chamber, UV absorbing, An overall diameter of $864.00
foldable, aspheric, acrylic, single 10.75mm and optic diameter
piece lens with apodised diffractive, of 6.15mm. From 0 to +35
trifocal optic and blue light dopters with 0.5 diopter
increments.
DV248 HOYA PY-60MV Preloaded in cartridge, Multifocal, +14.0D to 27.0D (0.5 steps) $864.00
Aspheric, Blue-blocker, Single Piece,
Hydrophobic
IS011 Medicontur BiFlex 677MY Posterior chamber IOL, 360° Special Optic diameter: 6.0 mm $864.00
Hydrophilic Acrylic Foldable Square Edge, ±0.10 mm, Overall diameter:
Multifocal Lens with Blue light Aspheric – Coma optimized – 13.0 mm ±0.20 mm
Multifocal – Diffractive Powers available:
+0.0 - +30.0 D ±0.25
D increment: 0.5 D
+3.5 D ±0.5 D
IQ022 PresiSAL Multifocal M302A Acrylic single piece, foldable Available in sperical $864.00
intraocular lens with anterior and dioptric powers from 0.0D
posterior optic-haptic square edge, to +30.0D. 1D steps: 0.0D
360 degree optic square edge design, to +10.0D; 0.5D steps:
precision power calculation. +10.5 to +17.5 and +28.5 to
Aberration technology, pupil +30.0; 0.25D steps: +18.0.0
independent diffractive anterior to +28.0; near sight
surface with a near sight correction correction addition up to
addition of up to +3.5D, and UV and +3.5D on all spherical
blue light fliters. dioptric powers.
Prostheses List by Category, Groups and Sponsor Page 25 of 1092
SO064 HumanOptics Diffractiva Y Multifocal posterior chamber IOL, Sphere: +10D to +30D, $864.00
foldable, UV absorber, Aspheric, Near addition +3.5D
aberration technology, 360° LEC
barrier, HD optic, Blue light filter
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.
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.
Prostheses List by Category, Groups and Sponsor Page 26 of 1092
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
BL031 TruLign Toric The TruLign Toric IOL, Models Overall diameter is 11.5mm $1,198.00
BL1AT/BL2AT and BL1UT/BL2UT (BL1AT,BL1UT,AT50T) or
is an accommodating IOL 12.0mm (BL2AT/BL2UT)
incorporating a toroidal posterior for the entire lens power
surface. The foldable IOL has a square range. Spherical equivalent
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 27 of 1092
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
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.
SO061 HumanOptics Torica Add-On IOL Toric Add-On IOL for sulcus fixation Sphere: -4.0 to +1.5 in 0.5D $740.00
in pseudophakic eyes, 3-piece, steps, Cylinder < 7D
foldable, UV absorber, blue light
filter, Iris protection, safety profile
technology and undulated haptics
SO062 HumanOptics Secura Add-On IOL Add-On IOL for sulcus fixation in -6.0 to +6.0 in 0.5D steps $385.00
pseudophakic eyes, 3-piece, foldable,
UV absorber, blue light filter, Iris
protection and safety profile
Prostheses List by Category, Groups and Sponsor Page 28 of 1092
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
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
EG014 REVERSO Multifocal Intraocular lens -3 to +3 $780.00
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
SO056 HumanOptics ToricaDiffractiva Toric Multifocal Add-On IOL for -2.0 to +0.5 in 0.5D steps, $1,240.00
Add-On IOL sulcus fixation in pseudophakic eyes, Cylinder < 7D, Near
3-piece, foldable, UV absorber, blue addition 3.5D
light filter, Iris protection, safety
profile technology and undulated
Prostheses List by Category, Groups and Sponsor Page 29 of 1092
SO068 HumanOptics Diffractiva Add-On Multifocal Add-On IOL for sulcus -6.0 to +6.0 in 0.5D steps, $864.00
IOL fixation in pseudophakic eyes, 3- Near addition 3.5D
piece, foldable, UV absorber, blue
light filter, Iris protection and safety
profile technology.
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
AO032 Healon Endocoat Viscoelastic 0.85ml $80.00
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)
Prostheses List by Category, Groups and Sponsor Page 30 of 1092
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
AO008 Healon, Intraocular Viscoelastic Sodium Hyaluronate 10mg/ml Healon 0.55ml & 0.85ml $80.00
AL005 DUOVISC VISCOELASTIC SYSTEM PROVISC contains sodium Small & large packs $110.00
hyaluronate, VISCOAT contains
chondroitin sulfate and sodium
hyaluronate
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
Prostheses List by Category, Groups and Sponsor Page 31 of 1092
DV231 Vision Blue Trypan blue dye for ophthalmic 0.5ml syringe $48.00
applications
EG013 Retidyne Tissue staining in Ophthalmic 0.5ml Syringe Vial $48.00
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
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)
IS001 Preloaded Capsulan Tension Ring Capsular tension ring preloaded 13/11mm $243.00
(acrylic)
Prostheses List by Category, Groups and Sponsor Page 32 of 1092
EG018 RINGJECT Preloaded Capsular tension ring 12/10, 13/11 $243.00
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 33 of 1092
RQ072 iStent Trabecular Micro-Bypass The iStent GTS100R and GTS100L 1.0mm in length, 0.33mm in $800.00
are micro-invasive glaucoma surgical height with a snorkel
devices which are implanted in an "ab length of 0.25mm
interno" procedure into the trabecular
meshwork to create a bypass through
the trabecular meshwok to Schlemm's
Canal to improve aqueous outflow
through the natural physiologic
pathway.
SO017 FCI Ptose-up Expanded PTFE 15cm long x 2 or 3mm wide $348.00
x 0.35mm thick
DV260 Meddev Eyelid Weight, Implantable Thin Profile eyelid implants for Gold Thin 0.6, 0.8, 1.0, 1.2, $425.00
patients with facial palsy 1.4, 1.6g
DE183 Lid Load Gold Eyelid Weights; Gold 0.6, 0.8, 1.0, 1.2, 1.4, 1.6 $425.00
grams
SO047 Meddev Eyelid Weight, Implantable Thin Profile eyelid implants for Gold Thin 0.6, 0.8, 1.0, 1.2, $425.00
patients with facial palsy 1.4, 1.6g
Prostheses List by Category, Groups and Sponsor Page 34 of 1092
DV259 Meddev Eyelid Weight, Implantable Thin Profile eyelid implants for Contour Gold 0.6, 0.8, 1.0, $800.00
patients with facial palsy. 1.2, 1.4, 1.6, 1.8g
DE182 Lid Load Gold Eyelid Weights; Gold 1.8, 2.0, 2.2, 2.4, 2.6, 2.8 $800.00
grams
SO046 Meddev Eyelid Weight, Implantable Thin Profile eyelid implants for Contour Gold 0.6, 0.8, 1.0, $800.00
patients with facial palsy. 1.2, 1.4, 1.6, 1.8g
RC001 LIDCHAIN Platinum Eyelid Implant Platinum Weights - 0.8, 1.0, 1.2, 1.4, $1,300.00
1.6, 1.8 grams
DV261 Meddev Eyelid Weight, Implantable Thin Profile eyelid implants for Platinum Thin 0.6, 0.8, 1.0, $1,300.00
Platinum patients with facial palsy 1.2, 1.4, 1.6g
Contour Platinum 0.6, 0.8,
1.0, 1.2, 1.4, 1.6, 1.8g
SO048 Meddev Eyelid Weight, Implantable Thin Profile eyelid implants for Platinum Thin 0.6, 0.8, 1.0, $1,300.00
Platinum patients with facial palsy 1.2, 1.4, 1.6g
Contour Platinum 0.6, 0.8,
1.0, 1.2, 1.4, 1.6, 1.8g
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
Prostheses List by Category, Groups and Sponsor Page 35 of 1092
DV256 LIS 052 "StenTube" Large Diameter Lachrymal Intubation 1.32mm Tube diameter $135.00
Set
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:
SYN05 Synthes Australia Pty Ltd $5,700.00
LEM03 Lions Eye Donation Service $770.00
LEM01 Lions Eye Donation Service $2,000.00
LEN01 Lions NSW Eye Bank $2,287.00
LEW01 Lions Eye Bank of Western Australia $2,500.00
QEB01 Queensland Eye Bank $2,321.00
SAE01 The Eye Bank of South Australia $1,890.00
Page 2 of 15
LEN04 Lions NSW Eye Bank $2,695.00
LEW03 Lions Eye Bank of Western Australia $3,000.00
SAE03 The Eye Bank of South Australia $2,849.00
LEM04 Lions Eye Donation Service $2,660.00
LEN03 Lions NSW Eye Bank $1,372.00
LEM02 Lions Eye Donation Service $150.00
LEN02 Lions NSW Eye Bank $343.00
LEW02 Lions Eye Bank of Western Australia $250.00
QEB02 Queensland Eye Bank $329.00
SAE02 The Eye Bank of South Australia $230.00
MVS23 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $1,396.00
QBB60 The Queensland Bone Bank $1,733.00
RNB02 Hunter New England Bone Bank $1,470.00
QBB56 The Queensland Bone Bank $2,195.00
TBV52 Donor Tissue Bank of Victoria $683.00
TBV53 Donor Tissue Bank of Victoria $1,364.00
NBB62 New South Wales Bone Bank $1,169.00
NBB61 New South Wales Bone Bank $2,131.00
NBB60 New South Wales Bone Bank $3,232.00
Page 3 of 15
QBB09 The Queensland Bone Bank $1,778.00
QBB10 The Queensland Bone Bank $751.00
TBV09 Donor Tissue Bank of Victoria $1,254.00
TBV10 Donor Tissue Bank of Victoria $2,247.00
NBB65 New South Wales Bone Bank $1,169.00
NBB64 New South Wales Bone Bank $2,131.00
NBB63 New South Wales Bone Bank $3,232.00
AUB08 Australian Biotechnologies $2,215.00
AUB04 Australian Biotechnologies $2,070.00
SYN02 Synthes Australia Pty Ltd $3,400.00
SYN01 Synthes Australia Pty Ltd $2,650.00
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
PBT62 Perth Bone and Tissue Bank $550.00
PBT10 Perth Bone and Tissue Bank $4,050.00
Page 4 of 15
PBT64 Perth Bone and Tissue Bank $2,050.00
PBT08 Perth Bone and Tissue Bank $2,950.00
QBB45 The Queensland Bone Bank $2,202.00
QBB03 The Queensland Bone Bank $2,789.00
PBT09 Perth Bone and Tissue Bank $3,550.00
PBT38 Perth Bone and Tissue Bank $900.00
TBV11 Donor Tissue Bank of Victoria $1,471.00
PBT63 Perth Bone and Tissue Bank $1,150.00
TBV12 Donor Tissue Bank of Victoria $2,508.00
AUB02 Australian Biotechnologies $2,457.00
QBB68 The Queensland Bone Bank $2,235.00
QBB67 The Queensland Bone Bank $2,789.00
NBB05 New South Wales Bone Bank $1,584.00
PBT03 Perth Bone and Tissue Bank $1,200.00
TBV07 Donor Tissue Bank of Victoria $935.00
TBV08 Donor Tissue Bank of Victoria $1,002.00
PBT11 Perth Bone and Tissue Bank $300.00
QBB12 The Queensland Bone Bank $232.00
Page 5 of 15
TBV17 Donor Tissue Bank of Victoria $596.00
AUB05 Australian Biotechnologies $2,451.00
QBB52 The Queensland Bone Bank $487.00
TBV14 Donor Tissue Bank of Victoria $1,017.00
PBT07 Perth Bone and Tissue Bank $2,664.00
PBT48 Perth Bone and Tissue Bank $3,032.00
PBT06 Perth Bone and Tissue Bank $1,981.00
SYN08 Synthes Australia Pty Ltd $1,450.00
SYN09 Synthes Australia Pty Ltd $1,800.00
QBB04 The Queensland Bone Bank $788.00
QBB14 The Queensland Bone Bank $2,437.00
TBV18 Donor Tissue Bank of Victoria $6,076.00
NBB09 New South Wales Bone Bank $1,193.00
TBV21 Donor Tissue Bank of Victoria $1,065.00
PBT15 Perth Bone and Tissue Bank $1,590.00
QBB11 The Queensland Bone Bank $6.00
PBT16 Perth Bone and Tissue Bank $854.00
ACT01 ACT Bone Bank $2,432.00
AUB03 Australian Biotechnologies $2,354.00
Page 6 of 15
CSA01 Rachel Forster Bone Bank $802.00
DHR01 Barwon Health Bone Bank $3,028.00
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 $2,932.00
QBB27 The Queensland Bone Bank $2,390.00
RNB01 Hunter New England Bone Bank $2,500.00
TBV26 Donor Tissue Bank of Victoria $2,812.00
QBB61 The Queensland Bone Bank $2,390.00
QBB28 The Queensland Bone Bank $2,390.00
NBB59 New South Wales Bone Bank $2,939.00
PBT21 Perth Bone and Tissue Bank $2,900.00
TBV46 Donor Tissue Bank of Victoria $1,517.00
NBB17 New South Wales Bone Bank $2,078.00
PBT24 Perth Bone and Tissue Bank $1,800.00
QBB30 The Queensland Bone Bank $1,758.00
QBB31 The Queensland Bone Bank $740.00
QBB23 The Queensland Bone Bank $2,483.00
QBB66 The Queensland Bone Bank $3,106.00
NBB57 New South Wales Bone Bank $3,595.00
NBB13 New South Wales Bone Bank $3,244.00
TBV24 Donor Tissue Bank of Victoria $2,567.00
NBB56 New South Wales Bone Bank $2,183.00
Page 7 of 15
NBB55 New South Wales Bone Bank $2,183.00
PBT19 Perth Bone and Tissue Bank $3,200.00
MVS02 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
PBT17 Perth Bone and Tissue Bank $4,220.00
TBV22 Donor Tissue Bank of Victoria $4,505.00
NBB10 New South Wales Bone Bank $3,595.00
QBB20 The Queensland Bone Bank $3,094.00
NBB11 New South Wales Bone Bank $3,372.00
MVS03 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB12 New South Wales Bone Bank $8,023.00
QBB22 The Queensland Bone Bank $4,717.00
TBV23 Donor Tissue Bank of Victoria $7,440.00
PBT18 Perth Bone and Tissue Bank $8,000.00
MVS04 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
PBT20 Perth Bone and Tissue Bank $4,220.00
TBV25 Donor Tissue Bank of Victoria $4,473.00
NBB15 New South Wales Bone Bank $3,780.00
QBB25 The Queensland Bone Bank $3,337.00
NBB14 New South Wales Bone Bank $1,690.00
TBV51 Donor Tissue Bank of Victoria $4,345.00
Page 8 of 15
MVS07 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB18 New South Wales Bone Bank $7,817.00
PBT25 Perth Bone and Tissue Bank $3,500.00
QBB32 The Queensland Bone Bank $2,930.00
TBV27 Donor Tissue Bank of Victoria $7,177.00
NBB54 New South Wales Bone Bank $3,053.00
PBT28 Perth Bone and Tissue Bank $2,000.00
MVS14 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
TBV29 Donor Tissue Bank of Victoria $1,347.00
MVS13 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
TBV28 Donor Tissue Bank of Victoria $935.00
TBV30 Donor Tissue Bank of Victoria $2,631.00
NBB21 New South Wales Bone Bank $3,759.00
PBT29 Perth Bone and Tissue Bank $2,940.00
QBB33 The Queensland Bone Bank $3,052.00
TBV31 Donor Tissue Bank of Victoria $3,532.00
MVS08 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB24 New South Wales Bone Bank $8,411.00
PBT30 Perth Bone and Tissue Bank $7,000.00
QBB37 The Queensland Bone Bank $4,717.00
TBV32 Donor Tissue Bank of Victoria $7,815.00
NBB22 New South Wales Bone Bank $3,500.00
PBT31 Perth Bone and Tissue Bank $2,000.00
QBB34 The Queensland Bone Bank $2,738.00
TBV33 Donor Tissue Bank of Victoria $3,209.00
Page 9 of 15
NBB23 New South Wales Bone Bank $1,546.00
PBT32 Perth Bone and Tissue Bank $1,500.00
QBB35 The Queensland Bone Bank $1,321.00
TBV34 Donor Tissue Bank of Victoria $1,331.00
QBB36 The Queensland Bone Bank $812.00
TBV37 Donor Tissue Bank of Victoria $2,021.00
NBB26 New South Wales Bone Bank $1,999.00
NBB50 New South Wales Bone Bank $3,998.00
QBB39 The Queensland Bone Bank $1,781.00
NBB51 New South Wales Bone Bank $2,162.00
MVS19 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB25 New South Wales Bone Bank $3,053.00
TBV49 Donor Tissue Bank of Victoria $2,685.00
MVS20 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB29 New South Wales Bone Bank $4,066.00
QBB43 The Queensland Bone Bank $3,354.00
NBB30 New South Wales Bone Bank $4,118.00
PBT33 Perth Bone and Tissue Bank $3,343.00
NBB27 New South Wales Bone Bank $3,583.00
PBT35 Perth Bone and Tissue Bank $2,800.00
TBV36 Donor Tissue Bank of Victoria $3,280.00
NBB28 New South Wales Bone Bank $3,595.00
Page 10 of 15
MVS09 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
PBT34 Perth Bone and Tissue Bank $4,200.00
TBV35 Donor Tissue Bank of Victoria $3,142.00
NBB53 New South Wales Bone Bank $1,874.00
NBB31 New South Wales Bone Bank $2,305.00
TBV38 Donor Tissue Bank of Victoria $2,165.00
PBT47 Perth Bone and Tissue Bank $1,921.00
QBB05 The Queensland Bone Bank $1,547.00
TBV40 Donor Tissue Bank of Victoria $1,492.00
TBV39 Donor Tissue Bank of Victoria $2,578.00
PBT60 Perth Bone and Tissue Bank $2,000.00
QBB47 The Queensland Bone Bank $871.00
TBV41 Donor Tissue Bank of Victoria $1,307.00
PBT40 Perth Bone and Tissue Bank $2,954.00
PBT65 Perth Bone and Tissue Bank $6,300.00
MVS18 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB06 New South Wales Bone Bank $3,913.00
PBT13 Perth Bone and Tissue Bank $1,800.00
QBB15 The Queensland Bone Bank $2,495.00
TBV19 Donor Tissue Bank of Victoria $3,671.00
NBB49 New South Wales Bone Bank $2,399.00
Page 11 of 15
NBB47 New South Wales Bone Bank $3,850.00
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 $705.00
AUB07 Australian Biotechnologies $1,854.00
AUB10 Australian Biotechnologies $2,184.00
NBB01 New South Wales Bone Bank $2,487.00
PBT61 Perth Bone and Tissue Bank $1,985.00
QBB62 The Queensland Bone Bank $2,124.00
TBV05 Donor Tissue Bank of Victoria $1,311.00
QBB65 The Queensland Bone Bank $1,584.00
NBB02 New South Wales Bone Bank $2,883.00
PBT01 Perth Bone and Tissue Bank $2,800.00
QBB01 The Queensland Bone Bank $2,124.00
TBV06 Donor Tissue Bank of Victoria $2,509.00
AUB09 Australian Biotechnologies $2,228.00
NBB69 New South Wales Bone Bank $3,530.00
QBB69 The Queensland Bone Bank $2,124.00
QBB59 The Queensland Bone Bank $2,124.00
QBB48 The Queensland Bone Bank $2,271.00
Page 12 of 15
QBB63 The Queensland Bone Bank $1,735.00
PBT02 Perth Bone and Tissue Bank $2,500.00
NBB33 New South Wales Bone Bank $2,778.00
TBV42 Donor Tissue Bank of Victoria $2,578.00
NBB68 New South Wales Bone Bank $3,425.00
NBB72 New South Wales Bone Bank $2,826.00
NBB73 New South Wales Bone Bank $2,826.00
NBB70 New South Wales Bone Bank $2,827.00
QBB70 The Queensland Bone Bank $2,124.00
PBT46 Perth Bone and Tissue Bank $2,800.00
NBB67 New South Wales Bone Bank $2,826.00
QBB58 The Queensland Bone Bank $2,124.00
TBV57 Donor Tissue Bank of Victoria $2,509.00
NBB71 New South Wales Bone Bank $2,826.00
QBB57 The Queensland Bone Bank $2,124.00
TBV47 Donor Tissue Bank of Victoria $2,030.00
MVS17 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
QBB51 The Queensland Bone Bank $2,091.00
TBV48 Donor Tissue Bank of Victoria $2,612.00
Page 13 of 15
NBB35 New South Wales Bone Bank $3,258.00
NBB36 New South Wales Bone Bank $3,301.00
PBT45 Perth Bone and Tissue Bank $2,635.00
QBB54 The Queensland Bone Bank $2,614.00
TBV45 Donor Tissue Bank of Victoria $2,941.00
TBV44 Donor Tissue Bank of Victoria $3,047.00
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 $3,094.00
PBT44 Perth Bone and Tissue Bank $5,000.00
NBB46 New South Wales Bone Bank $5,158.00
NBB45 New South Wales Bone Bank $1,874.00
MVS16 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB37 New South Wales Bone Bank $5,260.00
QBB55 The Queensland Bone Bank $4,694.00
QBB64 The Queensland Bone Bank $4,717.00
NBB44 New South Wales Bone Bank $7,059.00
QBB53 The Queensland Bone Bank $1,096.00
Page 14 of 15
NBB41 New South Wales Bone Bank $4,849.00
NBB43 New South Wales Bone Bank $3,170.00
NBB42 New South Wales Bone Bank $3,423.00
QBB02 The Queensland Bone Bank $964.00
NBB66 New South Wales Bone Bank $1,563.00
MVS15 Institute of Medical & Veterinary Science T/A South Australian Tissue Bank $2,290.00
NBB07 New South Wales Bone Bank $3,606.00
PBT14 Perth Bone and Tissue Bank $1,500.00
QBB16 The Queensland Bone Bank $2,495.00
TBV20 Donor Tissue Bank of Victoria $3,396.00
NBB40 New South Wales Bone Bank $2,399.00
NBB38 New South Wales Bone Bank $3,170.00
Page 15 of 15
Part C - Other Prostheses February 2015
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
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
MI150 MiniMed 640G Insulin Pump MiniMed 640G Insulin Pump with 1.8ml and 3.0ml $9,500.00
SmartGuard Technology and
continuous glucose monitoring
capability, designed to automatically
suspend insulin delivery before
dangerous lows occur, and
automatically resume after levels
recover.
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
BT153 BioMonitor Implantable cardiac monitor for 53.3mm x 42.7mm x 7.1mm, $3,900.00
continuous remote monitoring of 26 grams
patients with Atrial Fibrillation (AF)
or unexplained syncope
MI141 Reveal LINQ Insertable Cardiac Monitor 45 x 7 x 3.5mm, 1.18cc $3,900.00
Page 3 of 3
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