36C10G18R0150-005.xlsx
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36C10G18R0150 Attachment 1 - Price-Cost Schedule_ Dental Laboratory Services 02.xlsx
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BASE YEAR
36C10G18R0150 | VA -18-0000464 BASE YEAR
| CLIN | P/N Description | Estimated Quantity Base Year | Unit of Measure (UOM) | Proposed Unit Cost| Price | **3% SLA FEE | Total Proposed Cost | Price (SLA FEE INCLUDED) |
| 0001 | PFM Crowns + Survey Porcelain Crown (Noble Alloy) | 7,050 | Each | |||
| 0002 | PFM Crowns + Survey Porcelain Crown (High Noble Alloy) | 500 | Each | |||
| 0003 | PFM Bridges (Bridge units - Retainer and pontics) (Noble Alloy) | 7,600 | Each | |||
| 0004 | PFM Bridges (Bridge units - Retainer and pontics) (High Noble Alloy) | 500 | Each | |||
| 0005 | Full Gold Crowns + Survey Gold Crowns (Noble Alloy) | 3,800 | Each | |||
| 0006 | Full Gold Crowns + Survey Gold Crowns (High Noble Alloy) | 300 | Each | |||
| 0007 | Full Gold Bridges (bridge units) (Noble Alloy) | 850 | Each | |||
| 0008 | Full Gold Bridges (bridge units) (High Noble Alloy) | 200 | Each | |||
| 0009 | Implant supported Full gold restorations (Noble Alloy) | 600 | Each | |||
| 0010 | Implant supported Full Gold restorations (High Noble Alloy) | 120 | Each | |||
| 0011 | Implant supported restorations (PFM Noble Alloy) | 1,625 | Each | |||
| 0012 | Implant supported restorations (PFM High Noble Alloy) | 150 | Each | |||
| 0013 | Implant supported Bridge units (Retainer and pontics – PFM Noble Alloy) | 1,150 | Each | |||
| 0014 | Implant supported Bridge units (Retainer and pontics – PFM High Noble Alloy) | 150 | Each | |||
| 0015 | Implant supported restorations (All Ceramic/layered zirconia) | 450 | Each | |||
| 0016 | Implant supported restorations (Full contoured zirconia) | 450 | Each | |||
| 0017 | Implant supported restorations (Lithium di silicate) | 350 | Each | |||
| 0018 | Implant connecting bars (precious metal/titanium) | 35 | Each | |||
| 0019 | Resin-bonded bridges (Maryland Bridge) (bridge units) | 150 | Each | |||
| 0020 | Screw-retained restorations (not including final crown) | 420 | Each | |||
| 0021 | Porcelain laminate veneer | 450 | Each | |||
| 0022 | All-ceramic C&B prostheses (units) | 4,300 | Each | |||
| 0023 | C&B metal/titanium/zirconium substructures | 20 | Each | |||
| 0024 | Application of veneering porcelain to existing CDL submitted metal or ceramic C&B copings and FPD structures | 600 | Each | |||
| 0025 | Post and Core | 140 | Each | |||
| 0026 | CAD/CAM Abutment (Titanium) | 280 | Each | |||
| 0027 | CAD/CAM Abutment (Zirconia) | 140 | Each | |||
| 0028 | Removable Partial Denture Frameworks | 3,500 | Each | |||
| 0029 | Flexible Partial Dentures – Fully fabricated | 5,000 | Each | |||
| 0030 | Flexible Partial Dentures – Setup for Try-in | 700 | Each | |||
| 0031 | Flexible Partial Dentures – Process and Finish | 1,000 | Each | |||
| 0032 | Complete Denture – Fully fabricated (Premium Teeth, IPN or equivalent) | 1,000 | Each | |||
| 0033 | Complete Denture – Setup for Try-in (Premium Teeth, IPN or equivalent) | 4,000 | Each | |||
| 0034 | Complete Denture – Process and Finish | 3,600 | Each | |||
| 0035 | Transitional Removable Partial Denture (RPD) w/ Wrought Wire Clasps | 2,000 | Each | |||
| 0036 | Partial Denture – Setup for Try-in | 1,500 | Each | |||
| 0037 | Partial Denture – Process and Finish | 2,500 | Each | |||
| 0038 | Custom tray, Record Base, and Occlusal rims | 1,200 | Each | |||
| 0039 | Fabrication of Hard Acrylic Night Guards | 700 | Each | |||
| 0040 | Fabrication of dual Laminate bite guards | 1,200 | Each | |||
| 0041 | Fabricate Diagnostic Wax-ups | 1,200 | Each | |||
| 0042 | Fabricate Provisional Crowns and Fixed Partial Dentures | 1,000 | Each | |||
| 0043 | Denture repair (acrylic) | 300 | Each | |||
| 0044 | Record base and occlusal rim – full or partial (per arch) | 2,500 | Each | |||
| 0045 | Denture repair (additional teeth) | 100 | Each | |||
| 0046 | Mandibular Repositioning Devices (Sleep Apnea) | 500 | Each | |||
| 0047 | Trim cast Immediate Dentures | 200 | Each | |||
| 0048 | Template, vacuum-formed | 200 | Each | |||
| TOTAL COST |
| VENDOR IS TO COMPLETE ALL HIGHLIGHTED SPACES ON ALL FIVE TABS |
| *AFTER RECEIPT OF ORDER |
| ** SERVICE LEVEL AGREEMENT FEE |
OPTION YEAR 1
36C10G18R0150 | VA -18-0000464 OPTION YEAR 1
| CLIN | P/N Description | Estimated Quantity Option Year 1 | Unit of Measure (UOM) | Proposed Unit Cost|Price | **3% SLA FEE | Total Proposed Price (SLA FEE INCLUDED) |
| 1001 | PFM Crowns + Survey Porcelain Crown (Noble Alloy) | 7,050 | Each | |||
| 1002 | PFM Crowns + Survey Porcelain Crown (High Noble Alloy) | 500 | Each | |||
| 1003 | PFM Bridges (Bridge units - Retainer and pontics) (Noble Alloy) | 7,600 | Each | |||
| 1004 | PFM Bridges (Bridge units - Retainer and pontics) (High Noble Alloy) | 500 | Each | |||
| 1005 | Full Gold Crowns + Survey Gold Crowns (Noble Alloy) | 3,800 | Each | |||
| 1006 | Full Gold Crowns + Survey Gold Crowns (High Noble Alloy) | 300 | Each | |||
| 1007 | Full Gold Bridges (bridge units) (Noble Alloy) | 850 | Each | |||
| 1008 | Full Gold Bridges (bridge units) (High Noble Alloy) | 200 | Each | |||
| 1009 | Implant supported Full gold restorations (Noble Alloy) | 600 | Each | |||
| 1010 | Implant supported Full Gold restorations (High Noble Alloy) | 120 | Each | |||
| 1011 | Implant supported restorations (PFM Noble Alloy) | 1,625 | Each | |||
| 1012 | Implant supported restorations (PFM High Noble Alloy) | 150 | Each | |||
| 1013 | Implant supported Bridge units (Retainer and pontics – PFM Noble Alloy) | 1,150 | Each | |||
| 1014 | Implant supported Bridge units (Retainer and pontics – PFM High Noble Alloy) | 150 | Each | |||
| 1015 | Implant supported restorations (All Ceramic/layered zirconia) | 450 | Each | |||
| 1016 | Implant supported restorations (Full contoured zirconia) | 450 | Each | |||
| 1017 | Implant supported restorations (Lithium di silicate) | 350 | Each | |||
| 1018 | Implant connecting bars (precious metal/titanium) | 35 | Each | |||
| 1019 | Resin-bonded bridges (Maryland Bridge) (bridge units) | 150 | Each | |||
| 1020 | Screw-retained restorations (not including final crown) | 420 | Each | |||
| 1021 | Porcelain laminate veneer | 450 | Each | |||
| 1022 | All-ceramic C&B prostheses (units) | 4,300 | Each | |||
| 1023 | C&B metal/titanium/zirconium substructures | 20 | Each | |||
| 1024 | Application of veneering porcelain to existing CDL submitted metal or ceramic C&B copings and FPD structures | 600 | Each | |||
| 1025 | Post and Core | 140 | Each | |||
| 1026 | CAD/CAM Abutment (Titanium) | 280 | Each | |||
| 1027 | CAD/CAM Abutment (Zirconia) | 140 | Each | |||
| 1028 | Removable Partial Denture Frameworks | 3,500 | Each | |||
| 1029 | Flexible Partial Dentures – Fully fabricated | 5,000 | Each | |||
| 1030 | Flexible Partial Dentures – Setup for Try-in | 700 | Each | |||
| 1031 | Flexible Partial Dentures – Process and Finish | 1,000 | Each | |||
| 1032 | Complete Denture – Fully fabricated (Premium Teeth, IPN or equivalent) | 1,000 | Each | |||
| 1033 | Complete Denture – Setup for Try-in (Premium Teeth, IPN or equivalent) | 4,000 | Each | |||
| 1034 | Complete Denture – Process and Finish | 3,600 | Each | |||
| 1035 | Transitional Removable Partial Denture (RPD) w/ Wrought Wire Clasps | 2,000 | Each | |||
| 1036 | Partial Denture – Setup for Try-in | 1,500 | Each | |||
| 1037 | Partial Denture – Process and Finish | 2,500 | Each | |||
| 1038 | Custom tray, Record Base, and Occlusal rims | 1,200 | Each | |||
| 1039 | Fabrication of Hard Acrylic Night Guards | 700 | Each | |||
| 1040 | Fabrication of dual Laminate bite guards | 1,200 | Each | |||
| 1041 | Fabricate Diagnostic Wax-ups | 1,200 | Each | |||
| 1042 | Fabricate Provisional Crowns and Fixed Partial Dentures | 1,000 | Each | |||
| 1043 | Denture repair (acrylic) | 300 | Each | |||
| 1044 | Record base and occlusal rim – full or partial (per arch) | 2,500 | Each | |||
| 1045 | Denture repair (additional teeth) | 100 | Each | |||
| 1046 | Mandibular Repositioning Devices (Sleep Apnea) | 500 | Each | |||
| 1047 | Trim cast Immediate Dentures | 200 | Each | |||
| 1048 | Template, vacuum-formed | 200 | Each | |||
| TOTAL COST |
| VENDOR IS TO COMPLETE ALL HIGHLIGHTED SPACES ON ALL FIVE TABS |
| *AFTER RECEIPT OF ORDER |
| ** SERVICE LEVEL AGREEMENT FEE |
OPTION YEAR 2
36C10G18R0150 | VA -18-0000464 OPTION YEAR 2
| CLIN | P/N Description | Estimated Quantity Option Year 2 | Unit of Measure (UOM) | Proposed Unit Cost|Price | **3% SLA FEE | Total Proposed Cost| Price (SLA FEE INCLUDED) |
| 2001 | PFM Crowns + Survey Porcelain Crown (Noble Alloy) | 7,050 | Each | |||
| 2002 | PFM Crowns + Survey Porcelain Crown (High Noble Alloy) | 500 | Each | |||
| 2003 | PFM Bridges (Bridge units - Retainer and pontics) (Noble Alloy) | 7,600 | Each | |||
| 2004 | PFM Bridges (Bridge units - Retainer and pontics) (High Noble Alloy) | 500 | Each | |||
| 2005 | Full Gold Crowns + Survey Gold Crowns (Noble Alloy) | 3,800 | Each | |||
| 2006 | Full Gold Crowns + Survey Gold Crowns (High Noble Alloy) | 300 | Each | |||
| 2007 | Full Gold Bridges (bridge units) (Noble Alloy) | 850 | Each | |||
| 2008 | Full Gold Bridges (bridge units) (High Noble Alloy) | 200 | Each | |||
| 2009 | Implant supported Full gold restorations (Noble Alloy) | 600 | Each | |||
| 2010 | Implant supported Full Gold restorations (High Noble Alloy) | 120 | Each | |||
| 2011 | Implant supported restorations (PFM Noble Alloy) | 1,625 | Each | |||
| 2012 | Implant supported restorations (PFM High Noble Alloy) | 150 | Each | |||
| 2013 | Implant supported Bridge units (Retainer and pontics – PFM Noble Alloy) | 1,150 | Each | |||
| 2014 | Implant supported Bridge units (Retainer and pontics – PFM High Noble Alloy) | 150 | Each | |||
| 2015 | Implant supported restorations (All Ceramic/layered zirconia) | 450 | Each | |||
| 2016 | Implant supported restorations (Full contoured zirconia) | 450 | Each | |||
| 2017 | Implant supported restorations (Lithium di silicate) | 350 | Each | |||
| 2018 | Implant connecting bars (precious metal/titanium) | 35 | Each | |||
| 2019 | Resin-bonded bridges (Maryland Bridge) (bridge units) | 150 | Each | |||
| 2020 | Screw-retained restorations (not including final crown) | 420 | Each | |||
| 2021 | Porcelain laminate veneer | 450 | Each | |||
| 2022 | All-ceramic C&B prostheses (units) | 4,300 | Each | |||
| 2023 | C&B metal/titanium/zirconium substructures | 20 | Each | |||
| 2024 | Application of veneering porcelain to existing CDL submitted metal or ceramic C&B copings and FPD structures | 600 | Each | |||
| 2025 | Post and Core | 140 | Each | |||
| 2026 | CAD/CAM Abutment (Titanium) | 280 | Each | |||
| 2027 | CAD/CAM Abutment (Zirconia) | 140 | Each | |||
| 2028 | Removable Partial Denture Frameworks | 3,500 | Each | |||
| 2029 | Flexible Partial Dentures – Fully fabricated | 5,000 | Each | |||
| 2030 | Flexible Partial Dentures – Setup for Try-in | 700 | Each | |||
| 2031 | Flexible Partial Dentures – Process and Finish | 1,000 | Each | |||
| 2032 | Complete Denture – Fully fabricated (Premium Teeth, IPN or equivalent) | 1,000 | Each | |||
| 2033 | Complete Denture – Setup for Try-in (Premium Teeth, IPN or equivalent) | 4,000 | Each | |||
| 2034 | Complete Denture – Process and Finish | 3,600 | Each | |||
| 2035 | Transitional Removable Partial Denture (RPD) w/ Wrought Wire Clasps | 2,000 | Each | |||
| 2036 | Partial Denture – Setup for Try-in | 1,500 | Each | |||
| 2037 | Partial Denture – Process and Finish | 2,500 | Each | |||
| 2038 | Custom tray, Record Base, and Occlusal rims | 1,200 | Each | |||
| 2039 | Fabrication of Hard Acrylic Night Guards | 700 | Each | |||
| 2040 | Fabrication of dual Laminate bite guards | 1,200 | Each | |||
| 2041 | Fabricate Diagnostic Wax-ups | 1,200 | Each | |||
| 2042 | Fabricate Provisional Crowns and Fixed Partial Dentures | 1,000 | Each | |||
| 2043 | Denture repair (acrylic) | 300 | Each | |||
| 2044 | Record base and occlusal rim – full or partial (per arch) | 2,500 | Each | |||
| 2045 | Denture repair (additional teeth) | 100 | Each | |||
| 2046 | Mandibular Repositioning Devices (Sleep Apnea) | 500 | Each | |||
| 2047 | Trim cast Immediate Dentures | 200 | Each | |||
| 2048 | Template, vacuum-formed | 200 | Each | |||
| TOTAL COST |
| VENDOR IS TO COMPLETE ALL HIGHLIGHTED SPACES ON ALL FIVE TABS |
| *AFTER RECEIPT OF ORDER |
| ** SERVICE LEVEL AGREEMENT FEE |
OPTION YEAR 3
36C10G18R0150 | VA -18-0000464 OPTION YEAR 3
| CLIN | P/N Description | Estimated Quantity Option Year 3 | Unit of Measure (UOM) | Proposed Unit Cost|Price | **3% SLA FEE | Total Proposed Cost| Price (SLA FEE INCLUDED) |
| 3001 | PFM Crowns + Survey Porcelain Crown (Noble Alloy) | 7,050 | Each | |||
| 3002 | PFM Crowns + Survey Porcelain Crown (High Noble Alloy) | 500 | Each | |||
| 3003 | PFM Bridges (Bridge units - Retainer and pontics) (Noble Alloy) | 7,600 | Each | |||
| 3004 | PFM Bridges (Bridge units - Retainer and pontics) (High Noble Alloy) | 500 | Each | |||
| 3005 | Full Gold Crowns + Survey Gold Crowns (Noble Alloy) | 3,800 | Each | |||
| 3006 | Full Gold Crowns + Survey Gold Crowns (High Noble Alloy) | 300 | Each | |||
| 3007 | Full Gold Bridges (bridge units) (Noble Alloy) | 850 | Each | |||
| 3008 | Full Gold Bridges (bridge units) (High Noble Alloy) | 200 | Each | |||
| 3009 | Implant supported Full gold restorations (Noble Alloy) | 600 | Each | |||
| 3010 | Implant supported Full Gold restorations (High Noble Alloy) | 120 | Each | |||
| 3011 | Implant supported restorations (PFM Noble Alloy) | 1,625 | Each | |||
| 3012 | Implant supported restorations (PFM High Noble Alloy) | 150 | Each | |||
| 3013 | Implant supported Bridge units (Retainer and pontics – PFM Noble Alloy) | 1,150 | Each | |||
| 3014 | Implant supported Bridge units (Retainer and pontics – PFM High Noble Alloy) | 150 | Each | |||
| 3015 | Implant supported restorations (All Ceramic/layered zirconia) | 450 | Each | |||
| 3016 | Implant supported restorations (Full contoured zirconia) | 450 | Each | |||
| 3017 | Implant supported restorations (Lithium di silicate) | 350 | Each | |||
| 3018 | Implant connecting bars (precious metal/titanium) | 35 | Each | |||
| 3019 | Resin-bonded bridges (Maryland Bridge) (bridge units) | 150 | Each | |||
| 3020 | Screw-retained restorations (not including final crown) | 420 | Each | |||
| 3021 | Porcelain laminate veneer | 450 | Each | |||
| 3022 | All-ceramic C&B prostheses (units) | 4,300 | Each | |||
| 3023 | C&B metal/titanium/zirconium substructures | 20 | Each | |||
| 3024 | Application of veneering porcelain to existing CDL submitted metal or ceramic C&B copings and FPD structures | 600 | Each | |||
| 3025 | Post and Core | 140 | Each | |||
| 3026 | CAD/CAM Abutment (Titanium) | 280 | Each | |||
| 3027 | CAD/CAM Abutment (Zirconia) | 140 | Each | |||
| 3028 | Removable Partial Denture Frameworks | 3,500 | Each | |||
| 3029 | Flexible Partial Dentures – Fully fabricated | 5,000 | Each | |||
| 3030 | Flexible Partial Dentures – Setup for Try-in | 700 | Each | |||
| 3031 | Flexible Partial Dentures – Process and Finish | 1,000 | Each | |||
| 3032 | Complete Denture – Fully fabricated (Premium Teeth, IPN or equivalent) | 1,000 | Each | |||
| 3033 | Complete Denture – Setup for Try-in (Premium Teeth, IPN or equivalent) | 4,000 | Each | |||
| 3034 | Complete Denture – Process and Finish | 3,600 | Each | |||
| 3035 | Transitional Removable Partial Denture (RPD) w/ Wrought Wire Clasps | 2,000 | Each | |||
| 3036 | Partial Denture – Setup for Try-in | 1,500 | Each | |||
| 3037 | Partial Denture – Process and Finish | 2,500 | Each | |||
| 3038 | Custom tray, Record Base, and Occlusal rims | 1,200 | Each | |||
| 3039 | Fabrication of Hard Acrylic Night Guards | 700 | Each | |||
| 3040 | Fabrication of dual Laminate bite guards | 1,200 | Each | |||
| 3041 | Fabricate Diagnostic Wax-ups | 1,200 | Each | |||
| 3042 | Fabricate Provisional Crowns and Fixed Partial Dentures | 1,000 | Each | |||
| 3043 | Denture repair (acrylic) | 300 | Each | |||
| 3044 | Record base and occlusal rim – full or partial (per arch) | 2,500 | Each | |||
| 3045 | Denture repair (additional teeth) | 100 | Each | |||
| 3046 | Mandibular Repositioning Devices (Sleep Apnea) | 500 | Each | |||
| 3047 | Trim cast Immediate Dentures | 200 | Each | |||
| 3048 | Template, vacuum-formed | 200 | Each | |||
| TOTAL COST |
| VENDOR IS TO COMPLETE ALL HIGHLIGHTED SPACES ON ALL FIVE TABS |
| *AFTER RECEIPT OF ORDER |
| ** SERVICE LEVEL AGREEMENT FEE |
OPTION YEAR 4
36C10G18R0150 | VA -18-0000464 OPTION YEAR 4
| CLIN | P/N Description | Estimated Quantity Option Year 4 | Unit of Measure (UOM) | Proposed Unit Cost|Price | **3% SLA FEE | Total Proposed Cost| Price (SLA FEE INCLUDED) |
| 4001 | PFM Crowns + Survey Porcelain Crown (Noble Alloy) | 7,050 | Each | |||
| 4002 | PFM Crowns + Survey Porcelain Crown (High Noble Alloy) | 500 | Each | |||
| 4003 | PFM Bridges (Bridge units - Retainer and pontics) (Noble Alloy) | 7,600 | Each | |||
| 4004 | PFM Bridges (Bridge units - Retainer and pontics) (High Noble Alloy) | 500 | Each | |||
| 4005 | Full Gold Crowns + Survey Gold Crowns (Noble Alloy) | 3,800 | Each | |||
| 4006 | Full Gold Crowns + Survey Gold Crowns (High Noble Alloy) | 300 | Each | |||
| 4007 | Full Gold Bridges (bridge units) (Noble Alloy) | 850 | Each | |||
| 4008 | Full Gold Bridges (bridge units) (High Noble Alloy) | 200 | Each | |||
| 4009 | Implant supported Full gold restorations (Noble Alloy) | 600 | Each | |||
| 4010 | Implant supported Full Gold restorations (High Noble Alloy) | 120 | Each | |||
| 4011 | Implant supported restorations (PFM Noble Alloy) | 1,625 | Each | |||
| 4012 | Implant supported restorations (PFM High Noble Alloy) | 150 | Each | |||
| 4013 | Implant supported Bridge units (Retainer and pontics – PFM Noble Alloy) | 1,150 | Each | |||
| 4014 | Implant supported Bridge units (Retainer and pontics – PFM High Noble Alloy) | 150 | Each | |||
| 4015 | Implant supported restorations (All Ceramic/layered zirconia) | 450 | Each | |||
| 4016 | Implant supported restorations (Full contoured zirconia) | 450 | Each | |||
| 4017 | Implant supported restorations (Lithium di silicate) | 350 | Each | |||
| 4018 | Implant connecting bars (precious metal/titanium) | 35 | Each | |||
| 4019 | Resin-bonded bridges (Maryland Bridge) (bridge units) | 150 | Each | |||
| 4020 | Screw-retained restorations (not including final crown) | 420 | Each | |||
| 4021 | Porcelain laminate veneer | 450 | Each | |||
| 4022 | All-ceramic C&B prostheses (units) | 4,300 | Each | |||
| 4023 | C&B metal/titanium/zirconium substructures | 20 | Each | |||
| 4024 | Application of veneering porcelain to existing CDL submitted metal or ceramic C&B copings and FPD structures | 600 | Each | |||
| 4025 | Post and Core | 140 | Each | |||
| 4026 | CAD/CAM Abutment (Titanium) | 280 | Each | |||
| 4027 | CAD/CAM Abutment (Zirconia) | 140 | Each | |||
| 4028 | Removable Partial Denture Frameworks | 3,500 | Each | |||
| 4029 | Flexible Partial Dentures – Fully fabricated | 5,000 | Each | |||
| 4030 | Flexible Partial Dentures – Setup for Try-in | 700 | Each | |||
| 4031 | Flexible Partial Dentures – Process and Finish | 1,000 | Each | |||
| 4032 | Complete Denture – Fully fabricated (Premium Teeth, IPN or equivalent) | 1,000 | Each | |||
| 4033 | Complete Denture – Setup for Try-in (Premium Teeth, IPN or equivalent) | 4,000 | Each | |||
| 4034 | Complete Denture – Process and Finish | 3,600 | Each | |||
| 4035 | Transitional Removable Partial Denture (RPD) w/ Wrought Wire Clasps | 2,000 | Each | |||
| 4036 | Partial Denture – Setup for Try-in | 1,500 | Each | |||
| 4037 | Partial Denture – Process and Finish | 2,500 | Each | |||
| 4038 | Custom tray, Record Base, and Occlusal rims | 1,200 | Each | |||
| 4039 | Fabrication of Hard Acrylic Night Guards | 700 | Each | |||
| 4040 | Fabrication of dual Laminate bite guards | 1,200 | Each | |||
| 4041 | Fabricate Diagnostic Wax-ups | 1,200 | Each | |||
| 4042 | Fabricate Provisional Crowns and Fixed Partial Dentures | 1,000 | Each | |||
| 4043 | Denture repair (acrylic) | 300 | Each | |||
| 4044 | Record base and occlusal rim – full or partial (per arch) | 2,500 | Each | |||
| 4045 | Denture repair (additional teeth) | 100 | Each | |||
| 4046 | Mandibular Repositioning Devices (Sleep Apnea) | 500 | Each | |||
| 4047 | Trim cast Immediate Dentures | 200 | Each | |||
| 4048 | Template, vacuum-formed | 200 | Each | |||
| TOTAL COST |
| VENDOR IS TO COMPLETE ALL HIGHLIGHTED SPACES ON ALL FIVE TABS |
| *AFTER RECEIPT OF ORDER |
| ** SERVICE LEVEL AGREEMENT FEE |
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