.. 
. . . .
OVERVIEW OF

AN 
INTRAOCULAR LENS COSTS

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INSPECTOR GENERAL 
OFFICE OF 

OFFICE OF EVALUATION AND INSPECTIONS 
JUNE 1990  OFFICE OF INSPECTOR GENERAL 
The mission of the Ofce of Inspector Genera (OIG) is to promote the effciency, 
effectiveness and integrty of progrs in the United States Deparent of Health and Human 
Services (HS). It does thisby developing methods to detect and prevent frud, waste, and 
abuse  Create by statute in 1976, the Inspector General keeps both the Secreta and the 
progrs 
Ccongroess fululy and ncurenttly irnfor.med  about  or maagement problems and 
recommends corrective action. The OIG performs its mission by conducting' audits 
investigations, and inspections with approximately 1 400 staf strtegically located around the
OFFICE OF EVALUATION AND INSPECTIONS 
This report is prouced by the Offce of Evaluation and Inspections (OE!), oneof the thee 
major offces withn the OIG. The other two are the Offce of Audit Services andtheOfuce of 
Investigations. Inspections ar conducte in accordace withprofessionals  dads 
developed by OEl. These inspetions ar tyicaly short-term studies designed to determne 
progr 
effectiveness, effciency, and vulnerabilty tofraud or abuse. 
th 
Th 
report is an overvew of information collected durng  reent OIGstudiesregarding 
introcular lens prices. 
The report was prepar under the dition of Don McLaughlin, Regional Inspector Genera, 
and Jares H. Wolf, Deputy Regional Inspector Genera, Region Vll, Offce of Evaluation and 
Inspections. Parcipating in this project were the following people: 
City Region  Headquarters 
Kansas 
Team Leader  Wayne Powell 
Tim Dold, 
Deborah Walden Project Leader  Mark Krushat 
Brian Ritchie  AN OVERVIEW OF

INTRAOCULAR LENS COSTS

Richard P. Kusserow 
INSPECTOR GENERAL 
OEI. 07.89-o16664  JUNE 1990  AN OVERVIEW OF 
INTRAOCULA LENS COSTS 
Richard P. Kusserow

INSPECTOR GENERAL

OEI-07-89-01664  June 1990  SUMY

EXECUTIVE 
PURPOSE 
This report presents a summary of information collected during

three recent Office of Inspector General (OIG) studies

regarding intraocular lens (IOL) prices.

BACKGROUND 
The Medicare program funds 90 percent of the cataract surgeries 
States. 
performed in the united  During cataract surgery, the 
removed. In 
natural lens in the eye is  over 95 percent of the 
cataract surgeries anl einntsr.a ocular lens is implanted, replacing 
the removed natural  In addition to replacing a natural 
lens removed from the eye during cataract surgery, IOLs are 
also used to replace a natural lens missing due to disease or 
absence. 
congeni tal 
1 million cataract 
The Medicare program approved payment for 1. 
1988. 
surgeries in  Medicare allowed charges for IOLs billed in 
connection with 25 percent of these surgeries averaged about
$324 each. 
Based on OIG recommendations, Federal Regulations published 
February 8, 1990, established a single payment rate of $200 for 
IOLs provided to Medicare patients in connection with cataract 
surgery performed in an ambulatory surgical center (ASC). 
Prior to March 12, 1990, the effective date of these 
regulations, Medicare reimbursement for cataract surgeries 
performed on an outpatient basis or in an ASC were to be
reimbursed by Medicare based on charges subj ect to reasonable 
cost limitations. 
METHODOLOGY 
The information presented in each of the reports upon which

this overview is based, was gathered using three separate

samples. 
Information regarding the purchase of IOLs through the Federal

Supply Schedule (FSS) was gathered through telephone interviews 
with ophthalmologists and/or procurement specialists in a 
sample of Veterans Administration (VA) and military hospitals 
nationwide. The sample consisted of 10 VA and 10 military
hospitals . 
Information regarding the purchase of IOLs by Indian Health
Service 
(IHS) hospitals was gathered from the only four IHS 
performed. 
hospi tals where cataract surgery is  Interviews were  conducted with an ophthalmologist in each of the four

hospitals 
, and procurement specialists in three. 
Canadian IOL costs are based on information collected from a

sample of Canadian hospitals. In establishing our sample

Provincial Purchasing Directors in each of the ten Canadian

Provinces provided us with names of Canadian hospitals where

cataract surgery was performed. 
We asked purchasing directors 
in each of those hospitals to provide information regarding

hospital IOL prices and contracts. The rate of currency

exchange on December 31, 1989 , was used to convert Canadian

prices to U. S. dollars. We also interviewed purchasing

directors and ophthalmologists in 13 of the sample Canadian

hospitals. 
FINDINGS 
The average cost of an IOL is $155 in IHS hospitals and $110 in

Canadian hospitals

The IHS hospitals purchased 47 percent of their IOLs for under

$149 and Canadian hospitals purchased 93 percent of their IOLs

for under $149

IOLs are available on the FSS for $95 to $198

Low IOL prices can be achieved without high volume purchases

The IOL manufacturers are competi ti ve 
and respond to effective
negotiating techniques 
RECOMMENDATION 
I s 
Our findings lead us to conclude that Medicare  reimbursement 
rate for IOLs is considerably higher than the price established
in other markets. 
We recommend the Health Care Financing 
Administration explore reducing the IOL single payment 
$150. At that price
reimbursement rate to no more than 
Medicare allowed charges would be reduced by $55 
million. At 
$125 per lens savings would be $82 million and at $100 per lens
savings would be $110 million.  . . ..  ..  ..  ...   ...   ....    ......      ......      ......      ......      ......      ......
. . ..  ..  ..  ...   ...   ....    ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      ......      .....     .....     ....    ....    ....    ...   ...   ..  
TABLE OF CONTENTS

Page

EXECUTIVE SUMMRY.......................................

INTRODUCTION 
I?1JJi)?()S; 
1J1\  JCC;R()1JJql). . . . . 
METHODOLOGY. 
FINDINGS. 
The average cost of an IOL is $155 in IRS

hospi ta1s and $110 in Canadian hospitals...........

The IRS hospitals purchased 47 percent of

their IOLs for under $149 and Canadian

hospi ta1s purchased 93 percent of their

IOLs for under $149................................

IOLs are available on the FSS for

$95 to $198........................................

Low IOL prices can be achieved without

high volume purchases..............................

The IOL manufacturers are competi ti ve and 
respond to effective negotiating techniques........

RECOMMNDATION.  . . . .
A...... 
A-1 
APPENDIX  0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
ta1s 
Intraocular Lens Costs in IRS Rospi 
B............................................. 
B-1 
APPENDIX 
ta1s 
Intraocular Lens Costs in Canadian Rospi 
C............................................. 
C-1 
APPENDIX 
No Direct Correlation Exists Between 
IOL Volume and Price  INTRODUCTION

PURPOSE 
This report presents a summary of information collected during

three recent Office of Inspector General (OIG) studies

regarding intraocular lens (IOL) prices.

BACKGROUND 
The Medicare program funds 90 percent of the cataract surgeries 
states. 
performed in the united  During cataract surgery, the 
removed. In 
natural lens in the eye is  over 95 percent of the 
cataract surgeries an intraocular lens is implanted, replacing 
lens. 
the removed natural  In addition to replacing a natural 
lens removed from the eye during cataract surgery, IOLs are 
also used to replace a natural lens missing due to disease or 
absence. 
congeni tal 
1 million cataract 
The Medicare program approved payment for 1. 
surgeries performed in ambulatory surgical centers (ASCs) and 
1988. 
hospi tal outpatient departments in  Data released by the 
Public Health Service indicates the frequency of cataract

surgery continues to increase, with some moderation. Medicare 
allowed charges for IOLs billed in connection with 25 percent 
of these surgeries averaged about $324 per lens in 1988. 
Changes have occurred with the reimbursement and place of 
cataract surgery. Medicare reimbursement for cataract surgery 
performed in a hospital inpatient setting is based on
Diagnosis-Related Group (DRG) rates. A DRG rate covers all 
services and supplies connected with a surgery, including 
intraocular lenses for cataract surgery patients. However, 
advances in medical technology have shifted the majority of 
cataract surgeries into hospital outpatient facilities or ASCs. 
until recently, Medicare reimbursement for cataract surgeries 
performed on an outpatient basis or in an ASC were to be 
reimbursed by Medicare based on reasonable cost determinations. 
In these situations, intraocular lenses were to be billed and 
paid for separately. 
Five OIG studies have been conducted regarding the

reimbursement for intraocular lenses. The first study,

entitled "Medicare Cataract Implant Surgery, " (OAI-85-09-046), 
1986. 
was issued in  This study reported that Medicare 
reimbursement principles neither required nor encouraged

providers to obtain lenses at the lowest available price, and

that the average Medicare reasonable charge payment to an

ophthalmologist or an ASC for an IOL was $365. The inspection 
also found that discounts were available from major
 manufacturers 
, and that in Canada, the same U. S. manufactured 
$200. 
lenses averaged less than  This study estimated that over 
$31 million would have been saved in 1984 , if Medicare lens 
$200. 
payments had been capped at  The study recommended that a 
national cap, based on a generic prudent buyer concept, be 
established for lens payments when lenses are billed
separately. 
The second study, entitled "Medicare certified Amulatory 
1988. 
Surgical Centers " (OAI-09-88-00490), was issued in  This 
study reported that the problems regarding lens payments 
discussed in the 1986 report had not been resolved.
Manufacturers continued to offer discounts 
, incentives and 
rebates that were not passed on to the Medicare program, and 
that Medicare reimbursement policy did not provide an incentive
for providers to be prudent buyers. 
The OIG again recommended 
that the Health Care Financing Administration (HCFA) establish 
a national Part B reimbursement cap of $200 for any intraocular 
lens billed to Medicare.

More recently, we conducted three additional studies focusing 
on IOL prices, which are summarized in this overview report. 
The first was issued in the form of a Management Advisory 
Report (MA), entitled "Intraocular Lenses Purchased through 
the Federal Supply Schedule (FSS), " (OAI-07-89-01661) in 
November 1989. This study, reported that quality IOLs are 
available on the Federal Supply Schedule. The lenses cost $95 
to $198 , and that the majority of Veterans Administration (VA) 
medical centers and military hospitals purchase IOLs outside 
the FSS for under $200. The OIG recommended that the HCFA use 
rates. 
the information presented in adjusting IOL reimbursement 
The next study, entitled "Intraocular Lenses Purchased by
Indian Health Service (IHS) Hospitals, " (OAI-07-89-01662) was 
MA. 
issued January 4, 1990, in the form of a  This study 
reported that Indian Health Service Hospitals purchased 466 
IOLs for an average of $155, and that IOL manufacturers are 
competitive. The OIG recommended that the HCFA consider the 
prices paid by IHS hospitals for IOLs in adjusting Medicare IOL 
reimbursement rates. 
The most recent report , entitled "Intraocular Lens Costs in 
Canadian Hospitals, " (OAI-07-89-01660) issued April 26, 1990 
reported that Canadian hospitals purchase IOLs for an average 
of $110 each and that low prices can be achieved even for low 
volume purchases. Several effective negotiating techniques 
used by Canadian hospitals in securing IOL contracts were also 
reported. The OIG again recommended that the HCFA consider the 
prices paid by Canadian hospitals in adjusting Medicare IOL 
S. hospitals of 
reimbursement rates, and that the HCFA inform U.
report. It 
the effective contracting practices noted in the 
was noted that the Medicare program would save $99 million  annually if Medicare reimbursed for IOLs at the average

Canadian price of $110, rather than the current Medicare

reimbursement rate of $200. 
Federal Regulations published February 8 , 1990, became

effective March 12 , 1990, establishing a single payment rate of 
$200 for IOLs provided to Medicare patients in connection with 
cataract surgery performed in an ASC. They also serve as a 
base for IOL payments to hospitals for cataract surgeries 
performed in their outpatient departments. 
We recently received information from the Audit Division for

the National Health Program in London, England, that they

purchase IOLs from a U. S. manufacturer for approximately 30
pounds , ($50) each. The contract covers 15 000 one-piece
posterior chamber IOLs to be purchased during a 3-year period.
It also covers the purchase of necessary anterior chamber

lenses at the same price.

METHODOLOGY 
A different methodology was used to gather 1989 IOL price

information in each of the three studies summarized in this

report. 
In conducting the "Intraocular Lenses Purchased through the

Federal Supply Schedule" study, we contacted VA and military
hospital personnel. 
A list of the 166 VA medical centers 
VA. A similar 
nationwide was obtained from the  list of the 141 
military hospitals nationwide was also obtained. A random 
sample of 10 hospitals was then selected from each list, for a 
total of 20 hospitals where cataract surgery is performed. We 
conducted telephone interviews with an ophthalmologist and/or a 
facilities. 
procurement specialist in each of the 20 sample 
In conducting the "Intraocular Lenses Purchased by Indian 
Health Service Hospitals" study, information was gathered from 
the only four IHS hospitals where cataract surgery is 
performed. We conducted telephone interviews with an 
hospitals. 
ophthalmologist in each of the four  Procurement 
specialists in three of the four hospitals were also contacted 
to obtain information the ophthalmologist was unable to
provide. 
In conducting the  Intraocular Lens Costs in Canadian
Hospitals" 
study, we contacted provincial purchasing directors 
who provided the names of 19 Canadian hospitals where cataract
surgery is performed. 
We then contacted the hospital 
purchasing director in each of the 19 hospitals to solicit 
information regarding contract prices for IOLs purchased by
their hospitals. 
We requested the number of lenses purchased 
under their contracts, the time period covered by the
contracts 
, the types of lenses purchased (one-piece posterior  multi-
piece posterior, or anterior chamber) and lens stock
numbers. Finally, 
we requested information regarding any
discounts 
, free equipment, or supplies received in conjunction 
with IOL purchases. 
In addition to collecting IOL prices, we used discussion guides 
to conduct telephone interviews with 12 directors and 8 
ophthalmologists in 13 of the 19 Canadian hospitals. The 
remaining directors or ophthalmologists refused to be 
contacted. 
interviewed or could not be 
Our calculation of the average cost of an IOL in Canada is 
based on information received from 15 of the 19 hospitals. One 
of the 19 hospitals declined to participate in our study, and
another' 
s information was never received, resulting in the 
collection of IOL price information from only 17 hospitals. 
Information received from 2 of the 17 hospitals was 
insuff icient and could not be used. 
The currency rate of exchange between Canada and the united 
states on December 31, 1989, (. 8734 U. S. dollars for each 
prices for
Canadian dollar) was used in calculating U. s. 
Canadian IOLs. All Canadian IOL contract price information 
received, for which the contract time period is known, was in 
effect on that date.
 FINDINGS

The average cost of an IOL is $155 in IHS hospitals and $110 in

Canadian hospitals

In Fiscal Year 1989 , the IHS hospitals paid an average of $155 
for a total of 466 IOLs purchased from two well-known
miannu fatchtureers  , cnehithaer roft  whbiche ils oliswted .on  the FSS. The 
average price of an IOL in each of the IHS hospitals is shown
Average IOL Prices 
IHS Hospitals

Annual  Average
Contract 
Hospi tal  Volume  Dollars  Total Dollars 
218  $134.  29, 244. 
106  $166.  17, 626. 
$168.  078. 
$186.  484.
17 
Total  466  72, 434. 
Average IHS IOL Price  155. 
The sampled Canadian hospitals negotiated an average price of 
$110 for the purchase of 10,844 IOLs under annual contracts 
chart. 
wi th nine U. S. manufacturers, as shown in the following 
Average IOL Prices

Canadian Hospitals

Annual  Average
Contract 
Dollars 
Hospi tal  Volume  Total Dollars 
757  $ 90.  , 470. 
1400  $ 72.  101, 850. 
326  $109.  592. 
$148.  424.

1540  $128.  197  736.

990  $ 89.  060.

850  $ 94.  917.

252  $120.  343.

551  $123.  993.

#10/11  1473  $121.  178  733.
 Anual  Average
Contract 
Dollars 
Hospi tal  Volume  Total Dollars 
#12  1460  $118.  173, 462. 
#13  264  $245.  64, 796. 
#14  450  $112.  701. 50 
#15  481  $ 93.  079. 
Total  844  $ 1 191  160. 
Average  Canadian IOL Price  109. 
Overall average prices paid by the IHS hospitals ranged from 
$134 to $196. Negotiated prices for IOLs ranged from $125 to 
$278 per lens as shown in Appendix A. MUlti-piece posterior 
chamber lenses account for 416 (89 percent) of the lenses 
purchased in these hospitals. Even though one IHS hospital has 
negotiated to purchase one-piece posterior chamber lenses for 
$175 , none were purchased in 1989. 
Under their current contracts, overall average IOL prices in 
$245. 
the sampled Canadian hospitals ranged from $73 to 
lens, 
Negotiated prices for IOLs ranged from $68 to $279 per 
wi th only one Canadian hosBpi.t al paying more than $200 for an 
IOL as shown in Appendix  These contracts cover a variety of 
lens types, and represent over 10 percent of approximately
100, 000 IOLs implanted annually in Canada. 
It should be noted that the average Canadian IOL price of $110

includes the purchase of one-piece posterior chamber lenses

generally considered to be more expensive. The 
ophthalmologists interviewed indicated approximately 55 percent 
of the IOLs they purchase are one-piece lenses. Forty percent 
lenses, 
of the IOLs purchased are multi-piece posterior chamber 
lenses. 
and the remaining five percent are anterior chamber 
Eleven of the twelve Canadian purchasing directors interviewed 
indicated they purchase the contract IOLs on a consignment
basis. In 
such arrangements, the IOL manufacturer(s) provide 
the hospitals with an inventory consisting of a variety of lens 
styles and sizes. This inventory is provided to the hospital 
at no additional charge, and allows the hospital to pay for 
lenses as they are used.  ".".."-"-.-.".."."..."._.,,..........,.._.
The IHS hospitals purchased 47 percent of their IOLs for under

$149 and Canadian hospitals purchased 93 percent of their IOLs

for under $149

The IHS hospitals purchased 47 percent of their IOLs for under
$149. 
The Canadian hospitals purchase 93 percent of their IOLs 
$149. Collectively, 
for under  the IHS and Canadian hospitals 
purchase 91 percent of their IOLs for under $149. 
Percentage of IOLs by Price

Percentage of Total Volume 
120 
100  ._u._-- f3- 98 
80 -
. m..  ""''''''''_h.........,..._n,

40 ----_u 
Under $149 
Under $110  Under $201  Over $201 
Price 
IHS Hospitals  Canadian Hospitals 
Medicare reimbursement for most medical items is based on the 
50th percentile for customary charges and the 75th percentile 
afos ra a pnr eIvOaiLl)i.n g charge, rather than a fixed amount (i.  , $200
The sampled Canadian hospitals purchase 50 
percent of their IOLs for under $110, and the IHS hospitals
purchase nearly 50 percent (47 percent) for under $149. Both 
the IHS and sampled Canadian hospitals purchase 98 percent of

$200. 
their IOLs for less than  Only two percent of the IOLs 
purchased by IHS or Canadian hospitals cost in excess of the 
current Medicare reimbursement rate of $200 per lens. 
Appendices A and B display complete lists of IOL costs in the

IHS and Canadian hospitals.
 IOLs are available on the FSS for $95 to $198

Four IOL manufacturers have negotiated contracts with the VA to 
offer several different lenses on the FSS, all for under $200. 
The FSS prices for IOLs range from $95 to $198. A one-piece 
lens is available on the FSS for $198. 
The Food and Drug Administration approves all of the lenses on

the FSS. We found nothing which indicated that

ophthalmologists perceived lenses listed on the FSS as being

lower quality. The two ophthalmologists we contacted who use

IOLs listed on the FSS reported satisfaction with the quality

of the lenses.

Low IOL prices can be achieved without high volume purchases

No direct correlation exists between price and the number of 
IOLs purchased by either the IHS or Canadian hospitals. The 
average prices paid by the IHS hospitals ranged from $134 to 
218. 
$186 for volumes ranging from 48 to  The average prices 
paid by Canadian hospitals ranged form $73 to $245 for volumes 
1540. 
ranging from 50 to  There was no' significant correlation 
between volume and price in either case, as indicated in the 
charts in Appendix 
The IOL manufacturers are competitive and respond to effective

negotiating techniques

ophthalmologists interviewed in all four of the IHS hospitals 
indicated that IOL manufacturers are competitive and willing to 
business. In 
lower prices to acquire more  two of the four
facilities 
, the ophthalmologists indicated that price was a 
deciding factor in their decision to purchase IOLs outside the 
FSS. 
All 12 of the Canadian purchasing directors interviewed stated 
they had effectively reduced IOL prices over the last couple of
years. 
They attribute these price reductions to their 
negotiations and bidding processes for IOL contracts. All 
Canadian hospitals purchase their IOLs under negotiated
contracts.  solicitation, 
These contracts vary in terms of bid 
selection of lens types, information required from IOL 
companies and contract approval. On the average, four IOL 
manufacturers compete for the IOL contracts in each hospital. 
We found that:

Canadian hospitals solicit bids from several

contracts.

manufacturers when negotiating IOL 
The number of manufacturers competing for the IOL

contract (s) in each Canadian hospital ranged from
 three to seven, and averaged four per hospital. 
Purchasing directors hold the opinion that broader 
costs. 
bidding holds down 
Canadian hospi tala contracting with more than one 
manufacturer purchase IOLs for less 
The seven Canadian hospitals contracting with more 
than one IOL manufacturer pay an average of $90 per
lens. 
Hospi tals contracting with one manufacturer 
$102. 
exclusively pay an average of  Even though the 
average price difference is only $12, applying a per 
lens savings of $12 to the total volume of 5169 
lenses purchased by hospitals currently contracting 
wi th only one company would result in a $62, 028 
savings to Canadian hospitals. 
Contracts of 24 months or less produce lower average

IOL prices

Canadian IOL contract periods averaged 21 months 
months. 
ranging from 12 to 40  Canadian hospitals 
purchasing under contracts of 24 months or less paid 
IOL.  tals 
an average of $105 for each  Hospi 
purchasing under contracts in excess of 24 months 
paid an average of $122 per IOL, over $17 more per
lens. 
RECOMMNDATION 
Our findings lead us to conclude that Medicare I s reimbursement 
rate for IOLs is considerably higher than the price established
in other markets. 
We recommend the Health Care Financing 
Administration explore reducing the IOL single payment 
$150. At that price 
reimbursement rate to no more than 
Medicare allowed charges would be reduced by $55 million. At 
$125 per lens savings would be $82 million and at $100 per lens 
million. 
savings would be $110  ******************* *************
Appendix A

Intraocular Lens Costs

IHS Hospitals

Contract 
Manufacturer  Price 
Vol ume 
Company F  177  $125. 
Company  E/G/H  $143. 
Company  E/G/H  $143. 
******************* 47 Percent Under $149 (219) ************** 
Company  E/G/H  $158. 
Company  E/G/H  $169. 
Company F  $170. 
Company  $170. 
Company F  $185. 
Company F  $186. 
Company F  $186. 
Company  E/G/H  $200. 
98 Percent Under  $201  (457) 
Company E/G/H  $278. 
A-I  **  **  ** **  **  ** **  **  **  **  **  **  **  * * * 
Appendix B

Intraocular Lens Costs

Canadian Hospitals

Contract 
U. S. 
Manufacturer  V2olum0e  0 $68Pric.e
200 $69.
Company A
 1000 $74.

Company A

700 $78.

Company A

421129  $$8877..

Company A

Company A
 2 $89.

Company A
 2 $89.
268 $89.
Company E

Company E

148 $89.

Company E
 25 $89.

Company E
 10 $89.

Company E

811737  $$8899..

Company E

Company E

150 $91.

Company E
 60 $91.

395 $96.
Company D

Company D

76 $100.

Company G

27 $100.

Company C

240 $104.

Company B

300 $109.

Company F

Company F

50th  Percentile**2***6 (5   42$2) *1***0**9***.***
*******
50 $112.

Company F

400 $112.

Unknown 
127 $113.

Unknown 
Company E
 1400 $117.

52 $120.

Company H

200 $120.

Company H

292 $122.

Company H

60 $122.

Company E

108 $122.

Company G

Company G

2 $122.

* **7 5th  Percentile***** (8, 133) *******************
165 $122.

Company G

2 $122.

Company G

2 $122.

Company G

7 $122.

Company G

32 $122.

Company G

7 $122.

Company G

25 $122.

Company G

Company G

B-1  Contract 
Manufacturer  Volume  Price 
Company G
 $122. 
Company G
 $122. 
Company A
 122  $131. 
Company A
 $131. 
Company F
 1300  $132. 
Company E
 132  $135. 
Company H
 $139. 
Company C
 $148. 
*****************93  Percent  Under $149  (10  076) **************
Company F  $165. 
Company E  150  $165. 
Company F  312  $165. 
Company A  $174. 
Company E  $196. 
Company E  $196. 
Company E $196. 
****************98  Percent  Under $200  (10  728) ************** 
Company F

$222 
Company I  $240. 
Company E
 $257. 
Company E
 $257. 
Company E
 $257. 
Company E
 $257. 
Company E
 $275. 
Company E
 $275. 
Company E
 $275. 
Company F
 $275. 
Company E
 $278. 
Total Volume
 10, 844 
B-2
 Appendix C

No Direct Correlation Exists Between

Annual lOL Volume and Price

Canadian Hospitals

Price' 
Annual Volume 
$300 
1500 
$250 
1250 
$200 
1000 
$150
750 
$100
500 
$50 
250 
13 14 
10/11 12 
Hospital # 
Contract Volume  Average Price 
.Prices shown have been converted to 
S. dollars for comparison purposes 
Hospitals 
IHS 
Annual Volume  Price' 
250  $200 
200 
$150 
150 
$100 
100 
$50 
Hospital # 
Contract Volume  Average Price 
C-1