Gap Permitted Items for Prostheses ListDecember 2007
Minimum Maximum
Billing CodeBenefitBenefitProduct NameDescriptionSize
Advanced Biomedical Pty Ltd
AB001$6,950.00$7,100.00ATS Medical open pivot aortic valved graft model 502AGPyrolythic Carbon, Double Velour Polyester, Titanium21- 33mm
AB002$6,000.00$6,200.00ATS medical open pivot heart valve model 500FA Pyrolythic Carbon, Double Velour Polyester, Titanium16-33mm
standard flexi-cuff aortic valve series, ATS medical open
pivot heart valve model 500DM standard flexi-cuff mitral
AB064$6,000.00$6,200.00ATS medical open pivot heart valve model 501DA Pyrolythic Carbon, Double Velour Polyester, Titanium16-33mm
advanced performance (AP) aortic valve series, ATS
medical open pivot heart valve model 501DM advanced
performance (AP) mitral valve series
Advanced Medical Optics Australia Pty Ltd
AO004$780.00$950.00Intraocular Lens: Allergan AMO Array Multifocal UV Array Multifocal SA40N, Silicone, Foldable IOL6.0 mm Optic Diameter x 13.0mm overall length.
Absorbing Silicone Posterior Chamber IOL Model SA-40N
AO010$80.00$95.00Healon GV Intraocular Viscoelastic FluidSodium Hyaluronate 14mg/mL0.5mm and 0.85ml
AO016$680.00$728.00Verisyse AC IOLPhakic Intraocular Lens: Model Myopia. Composition: 5mm Optic Diameter x 8.5 overall length; 6mm
PMMAOptic Diameter x 8.5 overall length
AO017$680.00$728.00Verisyse AC IOLPhakic Intraocular Lens: Model Hyperopia. 5mm Optic Diameter x 8.5 overall length
Composition: PMMA
AO018$888.00$1,456.00Verisyse AC IOLPhakic Intraocular Lens: Model Toric5mm Optic Diameter x 7.5 overall length
AO019$156.00$680.00Verisyse AC IOLAphakic Model5mm Optic Diameter x 8.5 overall length
AO020$780.00$950.00ReZoom Acrylic Multifocal Intraocular LensAcrylic, foldable, posterior chamber, intraocular lens6.0mm Optic Diameter x 13.0mm overall length
AO023$780.00$950.00Tecnis Multifocal Intraocular LensTecnis Multifocal foldable Posterior Chamber +5.0 Diopter to 34.0 Diopter in 0.5 diopter
Diffractive Intraocular Lens Model ZM900. Posterior increments
Chamber lens with UV light-absorbing, foldable,
silicone, 3 piece with a diffractive posterior optic and a
Modified Prolate Anterior Surface Technology
Advanced Surgical Design & Manufacture Ltd
AE007$14.00$31.00MF-Cortex ScrewTitanium1.0 - 2.7mm dia, length 2 - 40mm
AE013$74.00$290.00Shaft Screw, Pure Threaded Pin, Manufactured from pure Titanium3.2 x 50 - 100mm, 4.0 x 70 - 110mm
AE046$936.00$1,121.00Active Mobile BearingMeniscal InsertSizes 1 - 5 Thickness 6 - 9.5mm
AE047$972.00$1,121.00Active Knee SystemUltracongruent Meniscal InsertSizes 1 - 5 Thickness 6 - 17.5mm
AE049$945.00$1,051.00Other Active Knee ComponentsMeniscal InsertSizes 1 - 5 Thickness 6 - 15.5mm
AE050$483.00$613.00Other Active Knee ComponentsPatellaSizes 1 - 5
Gap Permitted Items for Prostheses ListPage 1 of 46
Minimum Maximum
Billing CodeBenefitBenefitProduct NameDescriptionSize
AE061$158.00$204.00ASDM Bone PlatesTitanium 2.0mm MF Bone Plate, TitaniumMedium, Y-Shape, 8 hole;Double Y-Shape, 6
hole;L-Shape, right or left, 5 holes;L-Shape,
right or left, 9-13mm, 4 holes;Straight Plate, 6
hole;Curved plate, 6 hole
AE068$243.00$690.00ASDM Clavicle Compression SystemClavicle Compression Pin3.2 & 4.0 mm x 50mm - 130mm
Titanium Screw, Double Threaded
AE079$1,144.00$1,942.00Active Knee Ultra Plus Meniscal InsertUHMWPE Tibial Insert Posterior Stabilised - Fixed1 - 5, 6 - 17.5mm Thickness
AE099$2,652.00$3,192.00Active Knee System - Cementless Stemmed TibiaHA Cementless Stemmed TibiaSizes 1 to 5 (A-Narrow & B-Wide)
Advanced Surgical Technologies
AD118$160.00$266.00Transcend/Lineage Articulation SystemApical plug titaniumOne size only
AD120$235.00$270.00Transcend/Lineage Articulation SystemBone screw titanium6.5mm x 1.5 - 6cm in 0.5cm increments long
AD131$160.00$270.00WMT Perfecta Hip SystemPMMA cement spacer/Bone Plug9 - 21mm in 1mm increments
AD139$1,144.00$1,550.00Advance Total Knee SystemMedial pivot UHMWPE tibial0, 1, 2, 3, 4, 5, 6 in 10 - 25mm thicknesses
AD186$3,727.00$4,318.00Ortholoc Modular Total CondylarFemoral components CoCr Posterior Stabilised (PorousSmall, Medium, Large, Xlarge
Coated)
AD220$3,307.00$3,432.00CONSERVE PLUS Total Hip Resurfacing SystemCoCr Femoral Head - Super PolishedSizes 36mm - 54mm in 2mm increments
AD276$2,652.00$3,229.00Advance HA Coated Tibial BaseTitanium HA Coated Tibial Base1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 5+, 6
AD280$1,144.00$1,550.00Advance Double High Tibial InsertDouble-High Tibial Insert - UHMWPEAll inserts are available in Left and Right: Sizes
1.5, 0, 1, 2, 3, 4, 5, & 6, in the following
increments of 10, 12, 14, 17, 20 & 25mm
AD286$3,307.00$3,432.00BFH Total, A-classCobalt Chrome super finished femoral head. Size range 36mm to 56mm in 2mm increments each with -
from 36mm to 56mm in 2mm increments with 3 head 3.5mm, 0mm, + 3.5mm head lengths
lengths per size
AD299$4,272.00$4,420.00Advance HA Coated Femoral ComponentHA Coated Femoral Component1 - 6 Left and Right
AD300$3,727.00$4,150.00Advance Total Knee SystemFemoral CoCr PCR component porous and HA1, 2, 3, 4, 5, 6
AD313$5,084.00$6,300.00Conserve Total SUPERFIX ShellPorous coated, super finished, revision resurfacing cup50mm - 72mm OD
with fins and screws
AD322$235.00$380.00Quadra-Fix Acetabular ShellQuadra-Fix Double threaded, 6.5mm Cancellous Screw35mm - 80mm in 5mm increments
AD325$3,162.00$5,400.00Conserve Plus A-CLASS Resurfacing HeadCoCr A-CLASS super finished resurfacing femoral 36mm to 56mm in 2mm increments each with -
3.5mm, 0mm, + 3.5mm head lengths
AD329$2,900.00$3,276.00Procotyl L Acetabular CupUncemented porous HA acetabular cup42 - 68mm
AD335$2,288.00$2,354.00Dynasty Acetabular System / metal liner, large head Dynasty Metal linerID 28,32,36,38,40,42,44,48
AD336$1,160.00$1,560.00Dynasty Acetabular System /poly linerA-class Crosslinked polyethylene liner, standard and ID 22,28,32,36, 38,40,42,46
lipped, large head options
Alcon Laboratories (Aust.) Pty Ltd
AL017$780.00$1,180.00Alcon AcrySof ReSTOR PC Diffractive IOL Model SA60D3Posterior Chamber, UV absorbing, foldable, acrylic, +10.0 to +30.0 D
single piece lens with apodised diffractive optic
Gap Permitted Items for Prostheses ListPage 2 of 46
Minimum Maximum
Billing CodeBenefitBenefitProduct NameDescriptionSize
AL022$820.00$1,250.00Alcon AcrySof ReSTOR PC Diffractive IOL Natural ModelPosterior Chamber, UV absorbing, foldable, acrylic, +10.0 to +30.0 D
SN60D3single piece lens with apodised diffractive optic and
blue light protection.
AL023$572.00$830.00Alcon AcrySof Toric PC IOL ModelsPosterior chamber, UV absorbing, foldable, acrylic, SN60T3 (1.50 D cylinder), SN60T4 (2.25 D
toric, single piece lens with blue light protectioncylinder), SN60T5 (3.00 D cylinder), SN60T6
(3.75 D cylinder), SN60T7 (4.50 D cylinder),
SN60T8 (5.25 D cylinder), SN60T9 (6.00 D
cylinder)
AL027$820.00$1,220.00ReSTOR multipiece apodised diffractive blue light filteringFoldable acrylic mutli-piece lens with apodised +6 to +30 Diopters
PC IOL Model MN60D3diffractive optic and blue light protection
AL028$862.00$1,500.00ReSTOR apodized diffractive aspheric intraocular lens - UV and Blue Light Filtering Foldable Single-Piece +10.0 to +30.0D in 0.5 dioptre increments and
SN6AD3Apodized Diffractive Aspheric Optic Posterior +30.0D to +34.0D in 1.0 dioptre increments
Chamber Lens
American Medical Systems
AM019$865.00$990.00MONARC Sling SystemProduct includes - mesh and two needles with handles One Size Only
attached
Atrium Australia - Pacific Rim Pty Limited
AC005$77.00$82.00Atrium polypropolene mesh - surgical meshPolypropolene7.5 x 15cm
AC006$270.00$282.00Atrium polypropolene mesh - surgical meshPolypropolene30 x 30cm
AC007$87.00$96.00Atrium polypropolene mesh - surgical meshPolypropolene15 x 15cm
AC008$288.00$297.00Atrium polypropolene mesh - surgical meshPolypropolene26 x 36cm
AC009$90.00$96.00Atrium polypropolene mesh - surgical meshPolypropolene - Pre-shaped with hole6.5 x 12.5cm
AC010$77.00$82.00Atrium polypropolene mesh - surgical meshPolypropolene5 x 10cm
AC011$302.00$317.00Atrium polypropolene mesh - surgical meshPolypropolene mesh plugSmall, Medium, Large and Extra Large
AC012$1,800.00$2,650.00Atrium PTFE Vascular GraftRadially Supported (Ringed) PTFE Thin Wall4mm x 10cm - 10mm x 100cm
AC013$1,655.00$1,730.00Atrium PTFE Vascular GraftStraight PTFE Thin Wall6mm x 10cm - 10mm x 90cm
AC014$1,634.00$1,825.00Atrium PTFE Vascular GraftTapered PTFE Thin Wall4-6mm x 30cm - 6-8mm x 90cm
Austofix
AX003$105.00$145.00Austofix Intramedullary ScrewsHumeral Head Screw, stainless steel4.3mm
AX020$1,050.00$1,084.65S2 Nail SystemCannulated supracondylar nail, stainless steel11/13mm x 160-380mm
Austramedex (VIC) Pty Ltd
AR004$360.00$450.00Orbital RimOrbital rims, left and right extended. Models 9539, 9540 Left & right extended models 47 x 40mm Oribtal
Orbital Rim Onlay Implants 81001, 81002Rim Onlay Implants left & right 40 x 40mm
Austspine Pty Ltd
AJ001$1,390.00$1,575.00Preference II Pedicle Screw and Reduction screw/ Polyaxial Pedicle Screw and Reduction ScrewLength 25mm-60mm, Diameter 4.5mm-8.2mm
Preference- II pedical screw system
Gap Permitted Items for Prostheses ListPage 3 of 46
Minimum Maximum
Billing CodeBenefitBenefitProduct NameDescriptionSize
AJ002$158.00$225.00Preference II Pedicle screw systemSet Screw for Polyaxial Pedicle Screw SystemOne size
AJ003$428.00$750.00Preference - II pedicle screw systemFixation Rod for Preference-II Pedicle Screw Fixation Length 30mm-600mm, Diameter 6mm
System
AJ004$1,227.00$1,450.00Preference - II pedicle screw systemCross Link for Preference-II Pedicle Screw Fixation 4 sizes: 45mm, 55mm, 70mm and 90mm
System
AJ007$1,000.00$1,500.00JectOSInjectable synthetic bone graft substitute5cc
AJ008$1,340.00$1,800.00JectOS 10ccInjectable synthetic bone graft substitute10cc
AJ009$2,400.00$2,650.00Kasios KAGECervical interbody PEEK cage for anterior cervical Height 4mm - 10mm
surgery
AJ010$1,000.00$1,735.00KGBoneSynthetic bone substitute, custom-fit for KAGE 4mm-10mm
cervical interbody cage
Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd
AS120$860.00$978.50IVS Tunneller-Intravaginal Tunneller SystemIVS Tunneller System Trans Obuturator with two 50 cm (mesh)
stylets and polypropylene mesh
AS135$780.00$840.00DST™ Series EEA™ XLCircular Stapler5 sizes
B Braun Australia Pty Ltd
BB014$203.00$225.00Spine System EvolutionNutFor screws for 5.2 and 6mm rods
BB056$55.00$75.00BRAUN AUST Intramedullary NailsFixation ScrewsDia 4.5mm-6mm,Length 20mm-96mm
BB059$55.00$80.00BRAUN AUST Intramedullary NailsHuckstep Fine Thread Screw4.5mmx19mm-4.5mmx57mm
BB071$11.00$30.00Kirshner Wires all SizesSteelDia 0.8mm-3.0mm, Length 70mm-310mm
BB073$86.00$127.00Craniofix Titanium ClampsTitanium16mm
BB107$1,617.00$3,200.00BRAUN AUST Intramedullary NailsNail for small bonesDia 3mm-8mm
BB108$215.00$230.00Aneurysm ClipYasargil4.5mm x 150g to 25.0mm x 200g
BB159$300.00$542.00Bone ScrewMACS Polyaxial & Stabilisation, TitaniumDia 6.5 - 7mm, length 30 - 50mm
BB160$1,620.00$1,800.00Bone ScrewHMA Polyaxial, TitaniumDia 12mm, length 26 - 38mm
BB161$1,035.00$1,150.00Bone ScrewHMA Monoaxial, TitaniumDia 12mm, length 26 - 38mm
BB162$340.00$377.00Bone ScrewMACS Locking, TitaniumDia 12mm, length 4mm
BB165$225.00$250.00MACS TL Implant Set - NutTitaniumDia 15mm
BB168$86.00$140.00CraniofixTitanium skull fixation clamp20mm
BB174$1,620.00$1,800.00MACS TL Bone ScrewsPolyaxial screw - XL30mm and 40mm
BB211$2,400.00$4,250.00KLA Anterior Lumbar Cage SystemAnterior Lumbar Cage - PEEK9mm x 5 degrees, 11mm x 5 degrees, 13mm x 5
degrees, 11mm x 9 degrees, 13mm x 9 degrees,
15mm x 9 degrees, 13mm X 13 degrees, 15mm X
13 degrees
BB212$2,400.00$2,500.00CBK Anterior Cervical Cage SystemAnterior Cervical Cage - PEEK4.5mm, 5.5mm, 6.2mm, 7mm, 8mm, 9mm
BB219$540.00$600.00S4 Spinal SystemS4 Straight Rod - Titanium35mm - 60mm
Gap Permitted Items for Prostheses ListPage 4 of 46
Minimum Maximum
Billing CodeBenefitBenefitProduct NameDescriptionSize
BB220$540.00$600.00S4 Spinal SystemS4 Straight Rod - Titanium70mm - 180mm
BB221$675.00$750.00S4 Spinal SystemS4 Straight Rod - Titanium200mm - 500mm
BB222$630.00$700.00S4 Spinal SystemS4 Pre-bent Rod - Titanium35mm - 55mm
BB223$653.00$725.00S4 Spinal SystemS4 Pre-bent Rod - Titanium60mm - 100mm
BB224$1,395.00$1,550.00S4 Spinal SystemPolyaxial Screw - titanium various sizesAll sizes
BB225$1,395.00$1,550.00S4 Spinal SystemPolyaxial Screw - Titanium various sizesDiameter 6.0mm, 7.0mm & 8.0mm - all lengths 25 -
60mm
BB226$1,080.00$1,200.00S4 Spinal SystemMonoaxial Screw - titanium various sizesDiameter 4.5mm & 5mm - all lengths 25 - 60mm
BB227$1,080.00$1,200.00S4 Spinal SystemMonoaxial Screw - titanium various sizesDiameter 6.0mm, 7.0mm & 8.0mm - all lengths 25 -
60mm
BB228$1,125.00$1,250.00S4 Spinal SystemS4 Cross Connector - titaniumRigid 22mm - 41mm
BB229$1,350.00$1,500.00S4 Spinal SystemS4 Cross Connector - titaniumVariable 43mm - 75mm
BB230$203.00$225.00S4 Spinal SystemSet Screw - titaniumone size
BB252$4,500.00$5,000.00T. Lif Intervertebral Cage SystemT.Lif PEEK Intervertebral CageAll sizes
BB278$2,400.00$2,500.00Aesculap Interbody CageInterbody cageAll sizes
BB279$4,500.00$5,000.00TeCorp Vertebral Body Replacement SystemTeCorp CervicalAll sizes
BB280$4,856.00$5,395.00TeCorp Vertebral Body Replacement SystemTeCorp ThoracicAll sizes
BB281$4,856.00$5,395.00TeCorp Vertebral Body Replacement SystemTeCorp LumbarAll sizes
BB287$2,400.00$5,000.00Aesculap TLIF SystemPeek OptimaAll Sizes
BB290$620.00$680.00T-Bar Yasargil Aneurysm ClipT-Bar Yarsargil Aneurysm Clip, Titanium, Permanent 5mm-9mm, 45 Deg
Standard Fenestrated
BB291$620.00$680.00T-Bar Yasargil Aneurysm ClipT-Bar Yarsargil Aneurysm Clip, Titanium, Permanent 5mm-13mm, 90 Deg
Standard Fenestrated
BB292$460.00$482.00T-Bar Yasargil Aneurysm ClipT-Bar Yarsargil Aneurysm Clip, Pyhnox Cobalt Alloy, 5mm-9mm, 45 Deg
Permanent Standard Fenestrated
BB293$460.00$482.00T-Bar Yasargil Aneurysm ClipT-Bar Yarsargil Aneurysm Clip, Pyhnox Cobalt Alloy, 5mm-13mm, 90 Deg
Permanent Standard Fenestrated
BB294$11.00$13.00Aesculap Ligating ClipsAesculap Ligating Clips- Ligation Clips Titanium;PL561T- Large
BB300$11.00$13.00Aesculap Ligating ClipsAesculap Ligating Clips TitaniumPL568T - medium/large
Bard Australia Pty Ltd
BA001$1,900.00$1,957.00Memotherm Vascular Stents Memotherm nitinol self-expanding stent4mm - 20mm diameters, 2cm - 12 cm lengths
BA002$1,391.00$1,432.73Pura Vario StentSaxx balloon expandable stainless steel stent3mm - 14mm diameter, 13mm - 80mm length
BA004$2,884.00$2,970.52Encapsulated Carbon Lined Stent Graft AV access PTFE covered nitinol self-expanding stent4mm - 10mm diameter, 3cm - 8cm length
BA005$2,884.00$2,970.52Encapsulated Carbon Lined Stent GraftIliac / SFA PTFE covered nitinol self-expanding stent4mm - 10mm diameter, 3cm - 12cm length
BA009$2,064.00$2,125.92Simon Filter Femoral - 2110F, Simon Filter Jugular - 2210J, Nitinol self expanding vena cava filter - "Simon Nitinol 28mm Filter, 7Fr delivery
Simon Filter Anticubital - 2310AFilter"
Gap Permitted Items for Prostheses ListPage 5 of 46
Minimum Maximum
Billing CodeBenefitBenefitProduct NameDescriptionSize
BA010$2,150.00$2,500.00Recovery FilterNitinol self expanding vena cava filter28mm Filter, 7Fr delivery System
BA011$873.00$899.19Grafts VascularPolyester soft-woven graft - bifurcated13mm - 25mm diameter aortic diameter, 6.5mm -
12.5 mm Iliac/Femoral diameter
BA012$962.00$990.86Grafts VascularPolyester knitted grafts - bifurcated12mm - 24mm Aortic diameter, 6mm - 12mm
Iliac/Femoral diameter
BA014$980.00$1,009.40Grafts VascularAxillo-bifemoral polyester graft8mm-10mm diameter, 50cm- 100cm length
BA015$1,736.00$1,788.08Grafts VascularIntraluminal polyester graft20mm - 29mm diameter, 4cm - 8cm length
BA017$715.00$736.45Grafts VascularPolyester grafts - straight5mm - 25mm diameter, 50cm-75cm length
BA018$725.00$990.00Exs Bionit Vascular GraftsPolyester graft - EXS8mm - 10mm diameter, 35cm length
BA019$1,057.00$1,400.00Impra PTFE Vascular Grafts ePTFE graft - radially supported, thin wall, 10 - 50cm 4mm - 8mm diameter
long
BA020$919.00$946.57Impra PTFE Vascular Grafts ePTFE graft - thin wall, 10 - 50cm long3mm - 10mm diameter
BA021$1,325.00$1,900.00Impra PTFE Vascular GraftsePTFE graft - radially supported, thin wall, greater than 4 - 8mm diameter
50cm long
BA022$955.00$1,400.00Impra PTFE Vascular GraftsePTFE graft - radially supported, regular wall, 10-50cm 4 - 19mm diameter
long
BA023$1,325.00$1,800.00Impra PTFE Vascular GraftsePTFE graft - radially supported, regular wall, greater 4 - 10mm diameter
than 50cm long
BA024$1,159.00$1,300.00Impra PTFE Vascular GraftsePTFE graft - thin wall, greater than 50cm long3 - 10 diameter
BA025$919.00$990.00Impra PTFE Vascular GraftsePTFE graft - regular wall, 10-50cm long3 - 19mm diameter
BA026$1,075.00$1,450.00Impra PTFE Vascular GraftsePTFE graft - regular wall, greater than 50cm long3 - 10mm diameter
BA027$875.00$1,700.00Impra PTFE Vascular Grafts Distaflo ePTFE graft with preformed cuff6-10mm diameter, 40 - 80cm length
BA028$1,327.00$2,250.00Impra PTFE Vascular GraftsDistaflo ePTFE graft with preformed cuff and flex 6-10mm diameter, 40 - 80cm length
support
BA029$842.00$1,260.00Impra PTFE Vascular Grafts Venaflo ePTFE graft with preformed cuff4mm - 8mm diameter, 10cm - 50cm length
BA030$1,532.00$1,577.96Impra PTFE Vascular GraftsVenaflo ePTFE graft with preformed cuff and flex 4mm - 8mm diameter, 10cm - 50cm length
support
BA031$153.00$157.59Grafts VascularPolyester soft tissue patch 1mm thick 5cm x 10cm
BA032$286.00$294.58Grafts VascularPolyester soft tissue patch 1mm thick 10cm x 15cm
BA033$388.00$399.64Grafts VascularPolyester soft tissue patch 1mm thick 15cm x 20cm
BA034$459.00$472.77Grafts VascularPolyester soft tissue patch 1mm thick 20cm x 30cm
BA035$153.00$157.59Grafts VascularPTFE Felt 2mm thick5cm x 10cm
BA036$286.00$294.58Grafts VascularPTFE Felt 2mm thick10cm x 15cm
BA037$388.00$399.64Grafts VascularPTFE Felt 2mm thick15cm x 20cm
BA038$459.00$472.77Grafts VascularPTFE Felt 2mm thick20cm x 30cm
BA039$87.00$89.61Grafts VascularPolyester pledgetsRectangle, Oval, Circle, Square 2.9mm-8mm x
6mm - 9.5mm
Gap Permitted Items for Prostheses ListPage 6 of 46
Minimum Maximum
Billing CodeBenefitBenefitProduct NameDescriptionSize
BA040$349.00$359.47VitaCuff, Hickman Catheter Dialysis/Apheresis catheter, dual lumen, silicone36-45cm overall length
BA041$669.00$674.00Contigen Cross Linked Collagen Contigen Bard Collagen Implant for Stress Urinary 2.5cc per syringe
Incontinence
BA048$349.00$359.47VitaCuff, Broviac CathetersSilicone, with VitaCuff2.4 - 6.6 French Catheter
BA049$180.00$185.40Broviac CathetersWithout VitaCuff, silicone2.4 - 6.6 French Catheter
BA050$252.00$259.56Hickman Catheters SingleWithout VitaCuff, silicone 7 - 14.4F French Catheter
BA051$350.00$360.50Hickman Catheters DualWithout VitaCuff, silicone 7 - 9 French Catheter
BA052$415.00$427.45Hickman Catheters TripleWithout VitaCuff, silicone 13.5 French Catheter
BA053$349.00$359.47Vitacuff, Hickman Single Lumen CathetersSilicone, with VitaCuff 7 - 14.4F French Catheter
BA054$415.00$427.45Vitacuff, Hickman Dual Lumen CathetersSilicone, with VitaCuff 7 - 9 French Catheter
BA055$506.00$521.18Vitacuff, Hickman Triple CathetersSilicone, with VitaCuff 13.5 French Catheter
BA056$500.00$715.00Subcutaneous PortsHickman open-ended catheter, single lumen 8 - 9.6 French Catheter
BA057$521.00$727.00Groshong Subcutaneous PortsSingle or dual lumen catheter8 - 9.6 French Catheter
BA059$805.00$829.15Dual Lumen Subcutaneous PortsSilicone, Polyurethane or ChronoFlex Open-ended 7 - 10 French Catheter
Catheter
BA060$653.00$672.59Hickman Subcutaneous PortsLow-Profile6 - 6.6 French Catheter
BA089$203.00$209.09Impra PTFE Vascular Grafts ePTFE Cardiovascular Patch 0.4mm Oval20 x 90mm
BA090$764.00$786.92Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, Circular100 x 150mm
BA091$372.00$383.16Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, Rectangular50 x 75mm
BA092$372.00$383.16Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, Rectangular50 x 150mm
BA093$1,593.00$1,640.79Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, Rectangular, 30 x 30mm, 10 x 90mm, 30 x 60mm
Patch 0.4 Oval, Rectangular
BA095$313.00$322.39Impra PTFE Vascular Grafts ePTFE Cardiovascular, Patch 0.6mm, Rectangular25 x 150mm
BA125$323.00$332.69Groshong CatheterSingle Lumen, Sizes 3fr-8fr Groshong Valved-Closed Single Lumen, sizes 3fr-8fr
ended catheter
BA126$376.00$387.28Groshong CatheterSingle Lumen, Sizes 5fr-9.5fr Groshong Valved-Closed Dual Lumen, sizes 5fr-9.5fr
ended catheter
BA129$175.00$180.25Vascular CatheterPICC - may include a Groshong Valved - Closed ended Single Lumen 3Fr - 6Fr
PICC, Single Lumen 3Fr-6Fr
BA130$211.00$217.33Vascular CatheterPICC- may include a Groshong Valved - Closed ended Dual Lumen 4Fr - 7Fr
PICC, Single Lumen 4Fr-7Fr
BA140$357.00$367.71HemoGlide Long Term Haemodialysis CatheterKit contents: 14.5fr catheter, 18g guidewire introducer 15, 19, 23 & 27cm straight kit; 19 & 23cm Pre-
needle, 0.038" 70cm J-wire guidewire, 15fr PTFE curved kit; 19, 24 & 28cm and 31cm Pre-curved
introducer sheath, 8" tunnelling device, 10-12fr jugular kit.
dualator vessel dilator, 2 adhesive dressings, 2
injections caps, silicone attachable suture wing,
heparin label and instructions for use.
Gap Permitted Items for Prostheses ListPage 7 of 46
Minimum Maximum
Billing CodeBenefitBenefitProduct NameDescriptionSize
BA149$744.00$750.00Pelvicol natural implantFlexible Flat sheet of acellular porcine dermal collagen 4 x 18cm x 1.0mm
and elastin fibres
BA150$407.00$410.00Pelvicol natural implantFlexible Flat sheet of acellular porcine dermal collagen 4 x 7cm x 1.0mm
and elastin fibres
BA151$377.00$380.00Pelvicol natural implantFlexible Flat sheet of acellular porcine dermal collagen 2 x 12cm x 1.0mm
and elastin fibres
BA152$499.00$503.00Pelvicol natural implantFlexible Flat sheet of acellular porcine dermal collagen 2 x 20cm x 1.0mm
and elastin fibres
BA153$561.00$565.00Pelvicol natural implantFlexible Flat sheet of acellular porcine dermal collagen 4 x 12cm x 1.0mm
and elastin fibres
BA154$943.00$951.00Pelvicol natural implantFlexible Flat sheet of acellular porcine dermal collagen 8 x 12cm x 1.0mm
and elastin fibres
BA155$254.00$256.00Pelvicol natural implantFlexible Flat sheet of acellular porcine dermal collagen 2 x 4cm x 1.0mm
and elastin fibres
BA156$299.00$301.00Pelvicol natural implantFlexible Flat sheet of acellular porcine dermal collagen 2 x 7cm x 1.0mm
and elastin fibres
BA159$485.00$499.55HemoSplit Long Term Haemodialysis catheterHemoSplit is a carbothane long term dual lumen Standard Kit (straight15cm to42cm and pre-
catheter used to provide vascular access for curved 19cm to31cm), Microintroducer Kits
haemodialysis. It comprises of a double D lumen (straight 19cm to 42cm & pre-curved 19cm to
configuration catheter each lumen having an ID of 31cm)
2.3mm) with a fixed split tip (to 7.5cmm) which enables
blood flow rates as high as 500mls/minute. The
catheter shaft has a tissue ingrowth cuff to assist
BA162$1,055.00$1,225.00Bard CK Parastomal PatchBard CK Parastomal Patch12.5 x 15.5cm, 15.5 x 20.5cm
BA167$130.00$133.90Poly RadPICC CathetersSingle lumen open-ended Polyurethane3, 4, 5Fr with 70cm guide wire
BA168$130.00$133.90Poly RadPICC CathetersSingle Lumen open-ended Polyurethane4, 5Fr with 135cm guide wire
BA169$149.00$153.47Poly RadPICC CathetersDouble Lumen open-ended Polyurethane4, 5, 6Fr with 70cm guide wire
BA170$149.00$153.47Poly RadPICC CathetersDouble Lumen open-ended Polyurethane5, 6Fr with 135cm guide wire
BA171$1,075.00$2,000.00Dynaflo AK Bypass GraftPTFE Graft7 & 8mm diameter. 50, 60, 70, 80cm lengths
BA172$407.00$472.00PelvisoftPelviSoft Acellular Collagen BioMesh4 x 7 cm
BA173$943.00$1,333.00PelvisoftPelviSoft Acellular Collagen BioMesh8 x 12 cm
BA174$561.00$679.00PelvisoftPelviSoft Acellular Collagen BioMesh6 x 8 cm
BA175$327.00$336.81HemoGlide Long Term Haemodialysis Catheter14.5Fr Double D stepped tip cuffed catheter31cm PC2 Jugular Kit
BA177$541.00$615.00SlimPort Ultra Low Profile Implanted PortUltra SlimPort Low Profile Plastic/Titanium port with Port: 16.9 x 22.7mm (W) x 9.2mm (H); 2.9g Wt 6
attachable Chronoflex® single lumen catheterFr Catheter
BA178$1,900.00$1,957.00Luminex Vascular StentLuminex nitinol self-expanding stent4mm - 20mm diameters, 2cm - 12cm lengths
BA179$552.00$610.00Bard Ventralex Hernia PatchBard Ventrlex Hernia Patch, Large8cm x 8cm
Gap Permitted Items for Prostheses ListPage 8 of 46
Minimum Maximum
Billing CodeBenefitBenefitProduct NameDescriptionSize
BA180$429.00$465.00Salute II Disposable Fixation SystemFor the general surgeon who performs both inguinal 38cm (10, 30 or 60 Q-ring), 18cm (10 or 30 Q-ring)
and ventral hernia repairs, the Davol Salutell Fixation
Device provides permanent fixation of mesh to tissue,
with no sharp points or exposed edges due to the
smooth, strong, suture-like shape of the Q-ring.
Bausch & Lomb Surgical
BL024$195.00$290.00Oxane HDSilicone oil - RMN3 mixture10ml
BL026$385.00$510.00Akreos AO Micro Incision LensMicro Incision, posterior chamber, foldable acrylic, 6mm optic overall diameter 11.0mm(10D-15D),
aphakic, anterior & posterior edge modification, 10.7mm (15.50-22D), 10.5mm (22.50-30D)
preloaded, with aberration contro, intraocular lens
Biomet 3i Australia Pty Ltd
NW001$8.00$60.003i Abutment CompleteTitanium3.25 - 6mm diameter
NW002$52.00$420.003i Self Tapping Threaded Implants and 3i CoverscrewOsseotite/Ice3.25 - 6mm diameter
Biomet Australia Pty Ltd
BI036$1,850.00$2,080.00Rx90 Hip SystemPrimary Femoral Stem, Chrome Cobalt, Cemented9-17mm
BI066$1,750.00$2,315.00Stanmore Total Hip SystemModular Femoral Stem - Standard and Straight, ChromeSize 1-5
Cobalt
BI081$3,120.00$3,520.00Impact Modular Total Hip SystemFemoral Segment, Diaphyseal, Standard. Titanium10-15mm Diameter
BI082$3,120.00$3,620.00Impact Modular Total Hip SystemFemoral Segment, Metaphyseal. TitaniumSize 1-6 x Small/Medium
BI086$2,860.00$5,500.00Impact Modular Total Hip SystemFemoral Segment, Metaphyseal, Revision Cemented , Size 3-6 Small/Medium
Titanium
BI087$2,860.00$4,800.00Impact Modular Total Hip SystemFemoral Segment, Metaphyseal, Uncemented , Size 3-6, Small/Medium
BI089$3,520.00$4,020.00Hap Impact Stem (Various)Femoral Segment, Metaphyseal, HAP Coated, Size 3-6, Small/Medium
Uncemented, Titanium
BI094$745.00$1,273.00Mallory Head Hip SystemFemoral Head, Offset, Chrome Cobalt28,32mm
BI130$160.00$200.00Bio-Plug Cement RestrictorCanal Plug, UHMWPE"7-20mm"
BI131$158.00$260.00Mallory Head Hip SystemFemoral Sleeve, UHMWPE9-17mm
BI144$160.00$200.00Bio-Plug Cement RestrictorCompression plug, PMMASizes 8-25mm
BI180$3,068.00$6,240.00Maxim Complete Knee SystemConstrained Anatomic Femoral Component, Anatomic. 60-75mm
Chrome Cobalt
BI201$6,000.00$6,540.00AGC Total Knee - Dual Articular Knee SystemFemoral Component55 - 75mm
BI799$3,068.00$6,240.00Ascent Total Knee SystemFemoral Anatomic, posterior stabilised or constrained, X-Small to X-Large
closed box, cemented, chrome cobalt
BI876$260.00$520.00Endo II HeadModular Head Taper Insert - CoCr-6mm to +6mm
BI907$1,300.00$1,788.00TRAC Knee SystemBearing Posterior Stabilised UHMWPE59 - 91mm
BI933$3,068.00$6,240.00Vanguard SSK Knee SystemFemoral Component, CoCr, Ti55 to 80mm
Gap Permitted Items for Prostheses ListPage 9 of 46
Minimum Maximum
Billing CodeBenefitBenefitProduct NameDescriptionSize
BI935$1,750.00$2,315.00Generation 4 - Polished Hip SystemFemoral Stem, Cobalt Chrome, Cemented9-17mm
BI954$910.00$2,200.00AGC Total Knee - Dual Articular Knee SystemTibial Insert, Rotating59 - 83mm, 8 - 20mm Depth
Cardinal Health
CI002$527.00$1,000.00AVAmax SystemRadiopaque bone cement system11G & 13G
Carl Zeiss Pty Ltd
CZ003$322.00$468.00IOLTECH Intraocular Lens: Model BigbagIOLTECH Hydrophilic acrylic, foldable, PC, single 6.5mm optic diameter x 10.35 overall diameter
piece, Tri-haptic, square edge design, UV blocker
CZ007$322.00$395.00IOLTECH MICS IOLIOLTECH Hydrophilic acrylic, Anti vault haptics, PC, 5.5mm - 6.0mm optic X 12mm overall diameter
single piece, square edge design, UV blocker, contains
single use inserter
CZ008$312.00$322.00HydromaxHydrophobic Acrylic, Foldable, PC, 3-Piece, Square 6.0mm Optic x 12.5mm Overall Diameter
Edge Design, UV Blocker
CZ009$332.00$350.00EthosHydrophobic Acrylic, Foldable, PC, 3-Piece, Square 6.0mm Optic x 12.5mm Overall Diameter
Edged Design, UV Blocker, Pre-Loaded
CZ010$354.00$364.00XL Stabi ZO, Invent ZOHydrophilic Acrylic, Foldable, PC, Single Piece, Square 6.0mm Optic x 10.5mm Overall Diameter
Edge Design, UV Blocker, Tri-haptic, Quad Haptic,
Aspheric Optic
CZ011$374.00$390.00XL Stabi ZO Sky, Invent ZO SkyHydrophilic Acrylic, Foldable, PC, Single Piece, Square 6.0mm Optic X 10.5mm Overall Diameter
Edge Design, UV Blocker, Trihaptic, Quad Haptic,
Aspheric Optic, Pre-Loaded
City Medical Devices Australia (trading as Energy Orthopaedics)
CD011$2,600.00$3,680.00Atlas Acetabular Cup SystemTitanium & HAAtlas Cup 40-74mm
CD028$745.00$1,248.00ESOP HAFemoral Head CoCr22.2 -32mm
CD039$3,727.00$4,264.00Academia KneeCoCr, Titanium, Femoral, Tibial, Bearing, Stems & Femoral Implant 40-55
Patellar
CD047$988.00$1,400.00PharoCephalic Head, CoCr41-59mm
CD048$260.00$900.00PharoIntermediate Sleeve-5 to +10 (six sizes)
Coloplast Pty Ltd
CT004$653.00$780.00Soft Solid Testicular ProsthesisGel filled Testicular ProsthesisSmall, Medium, Large & Extra Large