26RS0002_-_Quote_Rate_Sheet.xlsx

XLSX spreadsheet 17 KB Posted

Attached to
26RS0002 - *SB only *Oral Surgery Services
Solicitation number
0000037899
Issued by
Shasta County, Shasta CDP, Shasta Lake City, Mount Shasta City, California

About this file

This is a bid rate sheet for the California Department of Veterans Affairs solicitation 26RS0002 for oral surgery services at the Veterans Home of California at Redding. The solicitation requests rates for a comprehensive range of oral surgical procedures including tooth extractions (simple and complex), impacted tooth removal, biopsies, lesion excisions, cyst and tumor removals, and abscess drainage. Estimated service quantities range from one to twenty procedures across multiple procedure codes, with panoramic X-rays estimated at twenty units and specialty consultations at five units. The rate sheet requires bidders to enter unit costs for each procedure, with all amounts becoming binding for the full contract term including any extensions through formal amendment. The state makes no guarantee regarding actual service volumes, which remain subject to change based on facility needs.

Pricing must be submitted as all-inclusive rates for each listed procedure, with any blank entries or zero dollar amounts potentially resulting in bid rejection or commitment to provide services at no cost, respectively. Bidders must complete the mandatory rate sheet with dollar amounts in the yellow-highlighted sections and submit it in accordance with solicitation instructions. For any authorized procedures not listed on the rate sheet, compensation will be calculated using the contractor's published usual and customary fee schedule reduced by ten percent, which must be provided by the awarded contractor upon contract execution. The basis of award is the lowest responsible bid, with the completed rate sheet becoming part of the agreement as Exhibit B-1.

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File Type Posted
26RS0002-_STD_213_Sample.pdf PDF
26RS0002_-_All_Attachments_(SFQ).pdf PDF
26RS0002_-_SFQ_SB.pdf PDF
26RS0002_-_All_Exhibits.pdf PDF

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Sheet1

California Department of Veterans AffairsSolicitation Number 26RS0002
Bid Rate SheetTBD
Oral Surgery Services

Submission of this attachment is MANDATORY. Upon award, the bid below will become part of the Agreement in Exhibit B-1, Rate Sheet. The Bidder shall enter the rates in the yellow-highlighted section below. An all-inclusive rate is required for each item listed below. Failure to indicate a dollar amount in any item may be grounds to reject the entire bid. A zero dollar ($0.00) amount listed for any and all items will be understood by the State that the bidder will perform any such services at no cost.

The Basis of Award shall be used to determine the lowest responsible bid. The State makes no guarantee, expressed or implied, on the actual amount of services that shall be required for this Agreement and is subject to change based on the needs of the Home. However, the rates quoted by Bidder shall be binding for the term of the Agreement, including any extension of the term through a formal amendment.

Enter the bid in the yellow-highlighted area.
Procedure CodeDescription of ServiceEstimated # of ServicesxUnit Cost=Totals
D7140Extraction, erupted tooth or exposed root5x=$0.00
D7210Extraction, erupted tooth requiring removal of bone and/or sectioning tooth, and including elevation of mucoperiosteal flap5x=$0.00
D7220Removal of impacted tooth-soft tissue5x=$0.00
D7230Removal of impacted tooth – partially bony10x=$0.00
D7240Removal of impacted tooth – complete bony10x=$0.00
D7241Removal of impacted tooth- completely bony with unusual surgical complications5x=$0.00
D7250Removal of residual roots(cutting procedure)5x=$0.00
D725Coronectomy-intentional partial tooth removal
1x=$0.00
D7260Oroantral fistula closure1x=$0.00
D7261Primary closure of Sinus Perforation1x=$0.00
D7285Incisional Biopsy of oral tissue – hard (bone, tooth)
3x=$0.00
D7286Incisional Biopsy of oral tissue –soft
5x=$0.00
D7287Exfoliative cytological sample collection5x=$0.00
D7288Brush biopsy5x=$0.00
D7311Alveoplasty in conjunction with extraction- one to three teeth or tooth spaces per quadrant1x=$0.00
D7310Alveoplasty in conjunction with extraction – four or more teeth or tooth spaces, per quadrant1x=$0.00
D7410Excision of benign lesion up to 1.25 cm
5x=$0.00
D7411Excision of benign lesion greater than 1.25 cm3x=$0.00
D7450Removal of benign odontogenic cyst or tumor – lesion diameter up to 1.25 cm1x=$0.00
D7451Removal of benign odontogenic cyst or tumor – lesion diameter greater than 1.25cm1x=$0.00
D7460Removal of benign non-odontogenic tumor or cyst – lesion diameter up to 1.25cm
1x=$0.00
D7461Removal of benign non-odontogenic tumor or cyst – lesion diameter greater than 1.25 am1x=$0.00
D7510Incision and drainage of abscess – intraoral soft tissue2x=$0.00
D7511Incision and drainage of abscess –intraoral soft tissue – complicated (includes drainage of multiple fascial spaces)2x=$0.00
70355Panorex X-ray20x=$0.00
D0220Intraoral Periapical Film5x=$0.00
D9310Specialty Consultation5x=$0.00
MISC.Authorized Procedures5x=$0.00
Total$0.00
Basis of Award
Contractor’s Usual and Customary Rates

Any services provided under this contract without a rate listed shall be paid at the Contractor’s Published Usual and Customary Fee Schedule, as specified in Exhibit B-2, less ten percent (10%). Contractor shall provide the Contractor’s Published Usual and Customary Fee Schedule along with the signed contract upon award.

This Rate Sheet Must be signed and returned.
The bid must be transmitted in accordance with the solicitation instructions

Printed Name and Title

Signature and Date

Company Name

Address

City, State, and ZIP

Telephone and Fax Number

Email

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