The file's text, extracted by GovTribe without its formatting.
5. PROJECT NUMBER (if applicable)
CODE
7. ADMINISTERED BY
2. AMENDMENT/MODIFICATION NUMBER
CODE
6. ISSUED BY
8. NAME AND ADDRESS OF CONTRACTOR
4. REQUISITION/PURCHASE REQ. NUMBER
3. EFFECTIVE DATE
9A. AMENDMENT OF SOLICITATION NUMBER
9B. DATED
PAGE OF PAGES
10A. MODIFICATION OF CONTRACT/ORDER NUMBER
10B. DATED
BPA NO.
1. CONTRACT ID CODE
FACILITY CODE
CODE
Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:
The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers
E. IMPORTANT:
is extended,
(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.
12. ACCOUNTING AND APPROPRIATION DATA
(REV. 11/2016)
is required to sign this document and return ___________ copies to the issuing office.
is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO:
Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.
15C. DATE SIGNED
B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).
RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.
C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:
D. OTHER
Contractor
16C. DATE SIGNED
14. DESCRIPTION OF AMENDMENT/MODIFICATION
16B. UNITED STATES OF AMERICA
Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.
15A. NAME AND TITLE OF SIGNER
16A. NAME AND TITLE OF CONTRACTING OFFICER
15B. CONTRACTOR/OFFEROR
STANDARD FORM 30
PREVIOUS EDITION NOT USABLE
Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)
(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)
(If required)
(SEE ITEM 11)
(SEE ITEM 13)
(X)
CHECK
ONE
13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,
IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT
(Signature of person authorized to sign) (Signature of Contracting Officer) 07-28-2020 None 36C259 Department of Veterans Affairs Network Contracting Office
NCO 19
6162 South Willow Drive, Suite 300 Greenwood Village CO 80111 36C259 Department of Veterans Affairs Network Contracting Office
NCO 19
6162 South Willow Drive, Suite 300 Greenwood Village CO 80111 To all Offerors/Bidders
36C25920Q0413 07-21-2020
X
X The purpose of this amendment is to provide the price/cost schedule.
Mary Emily Good Contracting Officer DENTAL LAB SERVICES FOR Rocky Mountain Regional VA Medical Center BASE YEAR: October 1, 2020 through September 30, 2021
QUANTITIES
COST
TOTAL
COST
Conventional Fixed Prosthodontics (Crown & Bridge)
| 0001 |
| Full Cast Crown/Pontic, High Noble Alloy *Alloy billed separately |
| 350 |
| EA |
| $ |
| $ |
| 0002 |
| Cast Inlay/Onlay/Multi-Surface, High Noble Alloy *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0003 |
| Full Cast Crown/Pontic, Noble Alloy *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0004 |
| Cast Inlay/Onlay/Multi-Surface, Noble Alloy *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0005 |
| Porcelain-Fused-to-High Noble Crown/Pontic *Alloy billed separately |
| 550 |
| EA |
| $ |
| $ |
| 0006 |
| Porcelain-Fused-to-Noble Crown/Pontic *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0007 |
| Full Contour Zirconia Crown/Pontic |
| 50 |
| EA |
| $ |
| $ |
| 0008 |
| Zirconia w/ Layered Porcelain Crown/Pontic |
| 20 |
| EA |
| $ |
| $ |
| 0009 |
| Porcelain-Fused-to-Alumina Crown/Pontic |
| 1 |
| EA |
| $ |
| $ |
| 0010 |
| Lithium Disilicate Pressed Crown/Pontic |
| 50 |
| EA |
| $ |
| $ |
| 0011 |
| Lithium Disilicate Pressed w/ Layered Porcelain Crown/Pontic |
| 10 |
| EA |
| $ |
| $ |
| 0012 |
| Lithium Disilicate Pressed Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0013 |
| Leucite Glass-Ceramic Pressed Crown |
| 1 |
| EA |
| $ |
| $ |
| 0014 |
| Leucite Glass-Ceramic Pressed Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0015 |
| [Layered Composite Services] Ceramage Crown/Pontic |
| 1 |
| EA |
| $ |
| $ |
| 0016 |
| [Layered Composite Services] Ceramage Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0017 |
| [Layered Composite Services] Ceramage FibreKor Maryland Bridge (includes one pontic) |
| 1 |
| EA |
| $ |
| $ |
| 0018 |
| [Layered Composite Services] Radica Crown/Pontic |
| 1 |
| EA |
| $ |
| $ |
| 0019 |
| [Layered Composite Services] Radica Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0020 |
| Layered Porcelain Veneer-Feldspathic (refractory technique) |
| 1 |
| EA |
| $ |
| $ |
| 0021 |
| [Maryland Bridge] Pontic (includes one model and die) |
| 1 |
| EA |
| $ |
| $ |
| 0022 |
| [Maryland Bridge] Wing (includes one model and die) |
| 2 |
| EA |
| $ |
| $ |
| 0023 |
| Provisional Temporary Crown/Pontic (Diagnostic Wax-up billed separately) |
| 40 |
| EA |
| $ |
| $ |
| 0024 |
| Custom Tray |
| 350 |
| EA |
| $ |
| $ |
| 0025 |
| Diagnostic Wax-up |
| 540 |
| EA |
| $ |
| $ |
| 0026 |
| Provisional Stent |
| 350 |
| EA |
| $ |
| $ |
| 0027 |
| Model Service |
| 1100 |
| EA |
| $ |
| $ |
| 0028 |
| Epoxy Model Service |
| 1 |
| EA |
| $ |
| $ |
| 0029 |
| Die Service |
| 550 |
| EA |
| $ |
| $ |
| 0030 |
| Duplicate Model Service |
| 175 |
| EA |
| $ |
| $ |
| 0031 |
| Articulation (for simple hinge articulators) |
| 775 |
| EA |
| $ |
| $ |
| 0032 |
| Articulation (for semi-adjustable articulators) |
| 275 |
| EA |
| $ |
| $ |
| 0033 |
| Articulation with Face Bow (for semi-adjustable articulators) |
| 50 |
| EA |
| $ |
| $ |
| 0034 |
| Porcelain Shoulder |
| 150 |
| EA |
| $ |
| $ |
| 0035 |
| Metal Occlusal |
| 100 |
| EA |
| $ |
| $ |
| 0036 |
| Design Crown for Partial |
| 100 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0037 |
| Fit to Existing Partial |
| 5 |
| EA |
| $ |
| $ |
| 0038 |
| Bridge Connector |
| 325 |
| EA |
| $ |
| $ |
| 0039 |
| Stress Breaker |
| 1 |
| EA |
| $ |
| $ |
| 0040 |
| Custom Shade (Includes two appointment process) |
| 5 |
| EA |
| $ |
| $ |
| 0041 |
| Rush Fee (per unit) |
| 5 |
| EA |
| $ |
| $ |
| 0042 |
| Cast Post & Core *Alloy billed separately |
| 12 |
| EA |
| $ |
| $ |
| 0043 |
| Laser Weld FDP Framework |
| 1 |
| EA |
| $ |
| $ |
| 0044 |
| Solder FDP Framework |
| 1 |
| EA |
| $ |
| $ |
| 0045 |
| Add Porcelain Contact |
| 10 |
| EA |
| $ |
| $ |
| 0046 |
| Add Solder Contact |
| 10 |
| EA |
| $ |
| $ |
| 0047 |
| Reduction Coping Resin |
| 20 |
| EA |
| $ |
| $ |
| 0048 |
| Alloy Estimate for High Noble Gold Crowns/Pontics/Inlays/Onlays *Changes with Gold Market |
| 750 |
| GRAM |
| $ |
| $ |
| 0049 |
| Alloy Estimate for Noble Gold Crowns/Pontics/Inlays/Onlays *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
| 0050 |
| Alloy Estimate for High Noble PFM Crowns/Pontics *Changes with Gold Market |
| 1300 |
| GRAM |
| $ |
| $ |
| 0051 |
| Alloy Estimate for Noble PFM Crowns/Pontics *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
Conventional Removable Prosthodontic
| 0052 |
| Process and Finish, Complete Denture, Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 90 |
| EA |
| $ |
| $ |
| 0053 |
| Process and Finish, Complete Denture, Heat Processed, Injection Moulded (Processed w/ Ivocap per Rx) |
| 10 |
| EA |
| $ |
| $ |
| 0054 |
| Set-Up for Try-In, Complete Denture *VA provides teeth |
| 210 |
| EA |
| $ |
| $ |
| 0055 |
| Process and Finish, Cast Framework Partial Denture (1-2 teeth), Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 5 |
| EA |
| $ |
| $ |
| 0056 |
| Process and Finish, Cast Framework Partial Denture (3-6 teeth), Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 15 |
| EA |
| $ |
| $ |
| 0057 |
| Process and Finish, Cast Framework Partial Denture (7 or more teeth), Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 30 |
| EA |
| $ |
| $ |
| 0058 |
| Set-Up for Try-In, Partial Denture (1 - 2 teeth) *VA provides teeth |
| 5 |
| EA |
| $ |
| $ |
| 0059 |
| Set-Up for Try-In, Partial Denture (3 - 6 teeth) *VA provides teeth |
| 40 |
| EA |
| $ |
| $ |
| 0060 |
| Set-Up for Try-In, Partial Denture (7 or more teeth) *VA provides teeth |
| 110 |
| EA |
| $ |
| $ |
| 0061 |
| Process and Finish, Acrylic Partial Denture (1 -2 teeth) *VA provides teeth |
| 80 |
| EA |
| $ |
| $ |
| 0062 |
| Process and Finish, Acrylic Partial Denture (3 -6 teeth) *VA provides teeth |
| 100 |
| EA |
| $ |
| $ |
| 0063 |
| Process and Finish, Acrylic Partial Denture (7 or more teeth) *VA provides teeth |
| 40 |
| EA |
| $ |
| $ |
| 0064 |
| Set-up, Process and Finish, Acrylic Partial Denture (1 -2 teeth) *VA provides teeth |
| 80 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0065 |
| Set-up, Process and Finish, Acrylic Partial Denture (3 -6 teeth) *VA provides teeth |
| 100 |
| EA |
| $ |
| $ |
| 0066 |
| Set-up, Process and Finish, Acrylic Partial Denture (7 or more teeth) *VA provides teeth |
| 40 |
| EA |
| $ |
| $ |
| 0067 |
| Cu-Sil Partial (first area) Soft Gasket |
| 1 |
| EA |
| $ |
| $ |
| 0068 |
| Cu-Sil Partial (each additional area) Soft Gasket |
| 1 |
| EA |
| $ |
| $ |
| 0069 |
| Repair, Complete Denture, Replace Denture Tooth *VA provides teeth |
| 50 |
| EA |
| $ |
| $ |
| 0070 |
| Repair, Complete Denture, Repair Acrylic Base |
| 25 |
| EA |
| $ |
| $ |
| 0071 |
| Repair, Partial Denture, Replace Denture Tooth *VA provides teeth |
| 50 |
| EA |
| $ |
| $ |
| 0072 |
| Repair, Partial Denture, Add Denture Tooth *VA provides teeth |
| 50 |
| EA |
| $ |
| $ |
| 0073 |
| Repair, Partial Denture, Replace Clasp Assembly |
| 25 |
| EA |
| $ |
| $ |
| 0074 |
| Repair, Partial Denture, Add Pre-Fabricated Clasp Assembly |
| 50 |
| EA |
| $ |
| $ |
| 0075 |
| Repair, Partial Denture, Laser Weld, Add/Replace Clasp Assembly |
| 30 |
| EA |
| $ |
| $ |
| 0076 |
| Repair, Partial Denture, Repair Acrylic Base |
| 25 |
| EA |
| $ |
| $ |
| 0077 |
| Reline, Complete Denture |
| 100 |
| EA |
| $ |
| $ |
| 0078 |
| Reline, Complete Denture, Soft Reline |
| 1 |
| EA |
| $ |
| $ |
| 0079 |
| Reline, Complete Denture, Molloplast-B Reline |
| 1 |
| EA |
| $ |
| $ |
| 0080 |
| Reline, Complete Denture, Same Day Turnaround |
| 1 |
| EA |
| $ |
| $ |
| 0081 |
| Reline, Partial Denture (1 - 6 teeth) |
| 10 |
| EA |
| $ |
| $ |
| 0082 |
| Reline, Partial Denture (7 or more teeth) |
| 10 |
| EA |
| $ |
| $ |
| 0083 |
| Rebase, Complete Denture |
| 1 |
| EA |
| $ |
| $ |
| 0084 |
| Reinforcement, Complete Denture, Pre-fabricated Mesh |
| 5 |
| EA |
| $ |
| $ |
| 0085 |
| Reinforcement, Complete Denture, Custom Cast Internal Framework |
| 2 |
| EA |
| $ |
| $ |
| 0086 |
| Wrought Wire Clasp |
| 500 |
| EA |
| $ |
| $ |
| 0087 |
| Ball Clasp |
| 50 |
| EA |
| $ |
| $ |
| 0088 |
| Name in Denture |
| 10 |
| EA |
| $ |
| $ |
| 0089 |
| Duplicate Denture (poured resin teeth) |
| 1 |
| EA |
| $ |
| $ |
| 0090 |
| Immediate Denture, Cast Surgery (1-2 teeth removed) |
| 25 |
| EA |
| $ |
| $ |
| 0091 |
| Immediate Denture, Cast Surgery (3-6 teeth removed) |
| 50 |
| EA |
| $ |
| $ |
| 0092 |
| Immediate Denture, Cast Surgery (7 or more teeth removed) |
| 25 |
| EA |
| $ |
| $ |
| 0093 |
| Custom Tray |
| 500 |
| EA |
| $ |
| $ |
| 0094 |
| Base Plate and Bite Rim |
| 500 |
| EA |
| $ |
| $ |
| 0095 |
| Model Service |
| 500 |
| EA |
| $ |
| $ |
| 0096 |
| Duplicate Model Service |
| 250 |
| EA |
| $ |
| $ |
| 0097 |
| Altered Cast Model Service |
| 10 |
| EA |
| $ |
| $ |
| 0098 |
| Articulation (for simple hinge articulators) |
| 10 |
| EA |
| $ |
| $ |
| 0099 |
| Articulation (for semi-adjustable articulators) |
| 250 |
| EA |
| $ |
| $ |
| 0100 |
| Wironium Partial Denture Framework (includes 2 clasps) |
| 135 |
| EA |
| $ |
| $ |
| 0101 |
| Wironium Unilateral Partial Denture Framework (includes 2 clasps) |
| 1 |
| EA |
| $ |
| $ |
| 0102 |
| Wironium Swing-Lock Partial Denture Framework (includes hinge/attachment components) |
| 1 |
| EA |
| $ |
| $ |
| 0103 |
| Wironium Complete Denture Cast Base |
| 1 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0104 |
| Wironium Obturator Framework |
| 1 |
| EA |
| $ |
| $ |
| 0105 |
| Additional Cast Clasp for Partial Denture Framework |
| 50 |
| EA |
| $ |
| $ |
| 0106 |
| Metal Pontic for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0107 |
| Metal Onlay for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0108 |
| Metal Backing for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0109 |
| Metal masking/Opaque for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0110 |
| Silicoating for Partial Denture Framework |
| 1 |
| EA |
| $ |
| $ |
| 0111 |
| DSE Hinge for Partial Denture Framework |
| 1 |
| EA |
| $ |
| $ |
| 0112 |
| Gold Framework for Partials *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0113 |
| Process and Finish, Flexible Partial Denture (1 -2 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0114 |
| Process and Finish, Flexible Partial Denture (3 -6 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0115 |
| Process and Finish, Flexible Partial Denture (7 or more teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0116 |
| Set-up, Process and Finish, Flexible Partial Denture (1 -2 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0117 |
| Set-up, Process and Finish, Flexible Partial Denture (3 -6 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0118 |
| Set-up, Process and Finish, Flexible Partial Denture (7 or more teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0119 |
| Denture Teeth, Dentsply Portrait IPN, Anterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0120 |
| Denture Teeth, Dentsply Portrait IPN, Anterior Teeth, Set of 6 |
| 5 |
| EA |
| $ |
| $ |
| 0121 |
| Denture Teeth, Dentsply Bioblend IPN, Anterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0122 |
| Denture Teeth, Dentsply Bioblend IPN, Anterior Teeth, Set of 6 |
| 50 |
| EA |
| $ |
| $ |
| 0123 |
| Denture Teeth, Dentsply Portrait IPN, Posterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0124 |
| Denture Teeth, Dentsply Portrait IPN, Posterior Teeth, Set of 6 |
| 5 |
| EA |
| $ |
| $ |
| 0125 |
| Denture Teeth, Dentsply Bioform IPN, Posterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0126 |
| Denture Teeth, Dentsply Bioform IPN, Posterior Teeth, Set of 6 |
| 50 |
| EA |
| $ |
| $ |
| 0127 |
| TMJ Hard Splint |
| 15 |
| EA |
| $ |
| $ |
| 0128 |
| TMJ Anterior Positioning Splint/Orthotic |
| 1 |
| EA |
| $ |
| $ |
| 0129 |
| FlexiSplint Semi-Soft Bruxism Splint |
| 60 |
| EA |
| $ |
| $ |
| 0130 |
| Hybrid Splint Hard/Soft |
| 240 |
| EA |
| $ |
| $ |
| 0131 |
| Mandibular Advancement Device, OSA, DreamTAP |
| 0 |
| EA |
| $ |
| $ |
| 0132 |
| Mandibular Advancement Device, OSA, DreamTAP-PAP |
Implant Prosthodontics (Fixed & Removable Prosthetics)
| 0133 |
| Porcelain-Fused-to-High Noble Implant Crown, Screw-Retained *Alloy billed separately, **VA provides cast-to abutment |
| 50 |
| EA |
| $ |
| $ |
| 0134 |
| Porcelain-Fused-to-Noble Implant Crown, Screw-Retained *Alloy billed separately, **VA provides cast-to abutment |
| 1 |
| EA |
| $ |
| $ |
| 0135 |
| Gold Implant Crown, High Noble, Screw-Retained *Alloy billed separately, **VA provides cast-to abutment |
| 25 |
| EA |
| $ |
| $ |
| 0136 |
| Gold Implant Crown, Noble, Screw-Retained *Alloy billed separately, **VA provides cast-to abutment |
| 1 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0137 |
| Zirconia Implant Crown, Full Contour, Screw Retained, Procera, with screw |
| 1 |
| EA |
| $ |
| $ |
| 0138 |
| Porcelain-Fused-to-Zirconia Implant Crown, Screw Retained *CAD/CAM Zirconia Abutment billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0139 |
| Porcelain-Fused-to-High Noble Implant Crown, Cement-Retained *Alloy billed separately |
| 50 |
| EA |
| $ |
| $ |
| 0140 |
| Porcelain-Fused-to-Noble Implant Crown, Cement-Retained *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0141 |
| Gold Implant Crown, High Noble, Cement-Retained *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0142 |
| Gold Implant Crown, Noble, Cement-Retained *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0143 |
| Zirconia Implant Crown, Cement-Retained |
| 25 |
| EA |
| $ |
| $ |
| 0144 |
| Zirconia w/ Layered Porcelain Implant Crown, Cement-Retained |
| 1 |
| EA |
| $ |
| $ |
| 0145 |
| Stock Abutment Modification *VA provides stock abutment |
| 10 |
| EA |
| $ |
| $ |
| 0146 |
| Custom Cast Abutment, High Noble *Alloy billed separately, **VA provides cast-to abutment |
| 10 |
| EA |
| $ |
| $ |
| 0147 |
| Custom Cast Abutment, Noble *Alloy billed separately, **VA provides cast-to abutment |
| 1 |
| EA |
| $ |
| $ |
| 0148 |
| Custom CAD/CAM Abutment, Straumann, Titanium with Screw |
| 50 |
| EA |
| $ |
| $ |
| 0149 |
| Custom CAD/CAM Abutment, Straumann, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0150 |
| Custom CAD/CAM Abutment, Procera, Titanium with Screw |
| 25 |
| EA |
| $ |
| $ |
| 0151 |
| Custom CAD/CAM Abutment, Procera, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0152 |
| Custom CAD/CAM Abutment, Atlantis, Titanium with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0153 |
| Custom CAD/CAM Abutment, Atlantis, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0154 |
| Custom CAD/CAM Abutment, BellaTek, Titanium with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0155 |
| Custom CAD/CAM Abutment, BellaTek, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0156 |
| Custom CAD/CAM Abutment, BellaTek with Encode Abutment, Titanium with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0157 |
| Custom CAD/CAM Abutment, BellaTek with Encode Abutment, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0158 |
| Fixed Detachable Hybrid Denture, Custom CAD/CAM Implant Connecting Bar (includes silicoating if needed) |
| 1 |
| EA |
| $ |
| $ |
| 0159 |
| Fixed Detachable Hybrid Denture, Set-up for Try-in *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0160 |
| Fixed Detachable Hybrid Denture, Process and Finish (Processed with Lucitone 199 per Rx) |
| 1 |
| EA |
| $ |
| $ |
| 0161 |
| Fixed Detachable Zirconia Bridge, Custom CAD/CAM Zirconia Framework/Structure (for use in full-arch restorations or when soft and hard tissue are being restored in a multi-unit FDP) |
| 1 |
| EA |
| $ |
| $ |
| 0162 |
| Bar Supported Overdenture, Custom CAD/CAM Implant Connecting Bar *VA provides prosthetic attachments |
| 1 |
| EA |
| $ |
| $ |
| 0163 |
| Bar Supported Overdenture, Wironium Super Structure Framework |
| 1 |
| EA |
| $ |
| $ |
| 0164 |
| Bar Supported Overdenture, Set-up for Try-in *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0165 |
| Bar Supported Overdenture, Process and Finish (Processed with Lucitone 199 per Rx) |
| 1 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0166 |
| Implant Retained Overdenture, Wironium Internal/External Framework |
| 5 |
| EA |
| $ |
| $ |
| 0167 |
| Implant Retained Overdenture, Cast Mesh Reinforcement |
| 5 |
| EA |
| $ |
| $ |
| 0168 |
| Implant Retained Overdenture, Set-up for Try-in *VA provides teeth |
| 25 |
| EA |
| $ |
| $ |
| 0169 |
| Implant Retained Overdenture, Process and Finish (Processed with Lucitone 199 per Rx) |
| 25 |
| EA |
| $ |
| $ |
| 0170 |
| Implant Attachment Pick-up by Laboratory, per attachment *VA provides prosthetic attachment |
| 50 |
| EA |
| $ |
| $ |
| 0171 |
| Surgical Stent with Guide Holes (Diagnostic Wax-up billed separately) |
| 50 |
| EA |
| $ |
| $ |
| 0172 |
| Surgical Stent with Barium Coating (Diagnostic Wax-up billed separately) |
| 1 |
| EA |
| $ |
| $ |
| 0173 |
| Implant Custom Tray |
| 150 |
| EA |
| $ |
| $ |
| 0174 |
| Implant Model Service with Soft Tissue Insert *VA provides implant/abutment analog |
| 100 |
| EA |
| $ |
| $ |
| 0175 |
| Implant Model Service from Stage One Surgery *VA provides implant/abutment analog |
| 1 |
| EA |
| $ |
| $ |
| 0176 |
| Abutment Position Verification Jig |
| 1 |
| EA |
| $ |
| $ |
| 0177 |
| Articulation (for simple hinge articulators) |
| 10 |
| EA |
| $ |
| $ |
| 0178 |
| Articulation (for semi-adjustable articulators) |
| 150 |
| EA |
| $ |
| $ |
| 0179 |
| Abutment Placement Jig |
| 150 |
| EA |
| $ |
| $ |
| 0180 |
| Diagnostic Wax-up |
| 50 |
| EA |
| $ |
| $ |
| 0181 |
| Duplicate Model Service |
| 50 |
| EA |
| $ |
| $ |
| 0182 |
| Radica Implant Crown, Screw Retained (Diagnostic Wax-up billed separeately) *VA provides temporary abutment |
| 25 |
| EA |
| $ |
| $ |
| 0183 |
| Implant Torch Wrench Kit (per usage) |
| 10 |
| EA |
| $ |
| $ |
| 0184 |
| Alloy Estimate for High Noble Gold Implant Crowns *Changes with Gold Market |
| 400 |
| GRAM |
| $ |
| $ |
| 0185 |
| Alloy Estimate for Noble Gold Implant Crowns *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
| 0186 |
| Alloy Estimate for High Noble PFM Implant Crowns *Changes with Gold Market |
| 700 |
| GRAM |
| $ |
| $ |
| 0187 |
| Alloy Estimate for Noble PFM Implant Crowns *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
DENTAL LAB SERVICES FOR Rocky Mountain Regional VA Medical Center OPTION YEAR #1: October 1, 2021 through September 30, 2022
QUANTITIES
COST
TOTAL
COST
Conventional Fixed Prosthodontics (Crown & Bridge)
| 0001 |
| Full Cast Crown/Pontic, High Noble Alloy *Alloy billed separately |
| 350 |
| EA |
| $ |
| $ |
| 0002 |
| Cast Inlay/Onlay/Multi-Surface, High Noble Alloy *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0003 |
| Full Cast Crown/Pontic, Noble Alloy *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0004 |
| Cast Inlay/Onlay/Multi-Surface, Noble Alloy *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0005 |
| Porcelain-Fused-to-High Noble Crown/Pontic *Alloy billed separately |
| 550 |
| EA |
| $ |
| $ |
| 0006 |
| Porcelain-Fused-to-Noble Crown/Pontic *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0007 |
| Full Contour Zirconia Crown/Pontic |
| 50 |
| EA |
| $ |
| $ |
| 0008 |
| Zirconia w/ Layered Porcelain Crown/Pontic |
| 20 |
| EA |
| $ |
| $ |
| 0009 |
| Porcelain-Fused-to-Alumina Crown/Pontic |
| 1 |
| EA |
| $ |
| $ |
| 0010 |
| Lithium Disilicate Pressed Crown/Pontic |
| 50 |
| EA |
| $ |
| $ |
| 0011 |
| Lithium Disilicate Pressed w/ Layered Porcelain Crown/Pontic |
| 10 |
| EA |
| $ |
| $ |
| 0012 |
| Lithium Disilicate Pressed Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0013 |
| Leucite Glass-Ceramic Pressed Crown |
| 1 |
| EA |
| $ |
| $ |
| 0014 |
| Leucite Glass-Ceramic Pressed Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0015 |
| [Layered Composite Services] Ceramage Crown/Pontic |
| 1 |
| EA |
| $ |
| $ |
| 0016 |
| [Layered Composite Services] Ceramage Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0017 |
| [Layered Composite Services] Ceramage FibreKor Maryland Bridge (includes one pontic) |
| 1 |
| EA |
| $ |
| $ |
| 0018 |
| [Layered Composite Services] Radica Crown/Pontic |
| 1 |
| EA |
| $ |
| $ |
| 0019 |
| [Layered Composite Services] Radica Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0020 |
| Layered Porcelain Veneer-Feldspathic (refractory technique) |
| 1 |
| EA |
| $ |
| $ |
| 0021 |
| [Maryland Bridge] Pontic (includes one model and die) |
| 1 |
| EA |
| $ |
| $ |
| 0022 |
| [Maryland Bridge] Wing (includes one model and die) |
| 2 |
| EA |
| $ |
| $ |
| 0023 |
| Provisional Temporary Crown/Pontic (Diagnostic Wax-up billed separately) |
| 40 |
| EA |
| $ |
| $ |
| 0024 |
| Custom Tray |
| 350 |
| EA |
| $ |
| $ |
| 0025 |
| Diagnostic Wax-up |
| 540 |
| EA |
| $ |
| $ |
| 0026 |
| Provisional Stent |
| 350 |
| EA |
| $ |
| $ |
| 0027 |
| Model Service |
| 1100 |
| EA |
| $ |
| $ |
| 0028 |
| Epoxy Model Service |
| 1 |
| EA |
| $ |
| $ |
| 0029 |
| Die Service |
| 550 |
| EA |
| $ |
| $ |
| 0030 |
| Duplicate Model Service |
| 175 |
| EA |
| $ |
| $ |
| 0031 |
| Articulation (for simple hinge articulators) |
| 775 |
| EA |
| $ |
| $ |
| 0032 |
| Articulation (for semi-adjustable articulators) |
| 275 |
| EA |
| $ |
| $ |
| 0033 |
| Articulation with Face Bow (for semi-adjustable articulators) |
| 50 |
| EA |
| $ |
| $ |
| 0034 |
| Porcelain Shoulder |
| 150 |
| EA |
| $ |
| $ |
| 0035 |
| Metal Occlusal |
| 100 |
| EA |
| $ |
| $ |
| 0036 |
| Design Crown for Partial |
| 100 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0037 |
| Fit to Existing Partial |
| 5 |
| EA |
| $ |
| $ |
| 0038 |
| Bridge Connector |
| 325 |
| EA |
| $ |
| $ |
| 0039 |
| Stress Breaker |
| 1 |
| EA |
| $ |
| $ |
| 0040 |
| Custom Shade (Includes two appointment process) |
| 5 |
| EA |
| $ |
| $ |
| 0041 |
| Rush Fee (per unit) |
| 5 |
| EA |
| $ |
| $ |
| 0042 |
| Cast Post & Core *Alloy billed separately |
| 12 |
| EA |
| $ |
| $ |
| 0043 |
| Laser Weld FDP Framework |
| 1 |
| EA |
| $ |
| $ |
| 0044 |
| Solder FDP Framework |
| 1 |
| EA |
| $ |
| $ |
| 0045 |
| Add Porcelain Contact |
| 10 |
| EA |
| $ |
| $ |
| 0046 |
| Add Solder Contact |
| 10 |
| EA |
| $ |
| $ |
| 0047 |
| Reduction Coping Resin |
| 20 |
| EA |
| $ |
| $ |
| 0048 |
| Alloy Estimate for High Noble Gold Crowns/Pontics/Inlays/Onlays *Changes with Gold Market |
| 750 |
| GRAM |
| $ |
| $ |
| 0049 |
| Alloy Estimate for Noble Gold Crowns/Pontics/Inlays/Onlays *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
| 0050 |
| Alloy Estimate for High Noble PFM Crowns/Pontics *Changes with Gold Market |
| 1300 |
| GRAM |
| $ |
| $ |
| 0051 |
| Alloy Estimate for Noble PFM Crowns/Pontics *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
Conventional Removable Prosthodontic
| 0052 |
| Process and Finish, Complete Denture, Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 90 |
| EA |
| $ |
| $ |
| 0053 |
| Process and Finish, Complete Denture, Heat Processed, Injection Moulded (Processed w/ Ivocap per Rx) |
| 10 |
| EA |
| $ |
| $ |
| 0054 |
| Set-Up for Try-In, Complete Denture *VA provides teeth |
| 210 |
| EA |
| $ |
| $ |
| 0055 |
| Process and Finish, Cast Framework Partial Denture (1-2 teeth), Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 5 |
| EA |
| $ |
| $ |
| 0056 |
| Process and Finish, Cast Framework Partial Denture (3-6 teeth), Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 15 |
| EA |
| $ |
| $ |
| 0057 |
| Process and Finish, Cast Framework Partial Denture (7 or more teeth), Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 30 |
| EA |
| $ |
| $ |
| 0058 |
| Set-Up for Try-In, Partial Denture (1 - 2 teeth) *VA provides teeth |
| 5 |
| EA |
| $ |
| $ |
| 0059 |
| Set-Up for Try-In, Partial Denture (3 - 6 teeth) *VA provides teeth |
| 40 |
| EA |
| $ |
| $ |
| 0060 |
| Set-Up for Try-In, Partial Denture (7 or more teeth) *VA provides teeth |
| 110 |
| EA |
| $ |
| $ |
| 0061 |
| Process and Finish, Acrylic Partial Denture (1 -2 teeth) *VA provides teeth |
| 80 |
| EA |
| $ |
| $ |
| 0062 |
| Process and Finish, Acrylic Partial Denture (3 -6 teeth) *VA provides teeth |
| 100 |
| EA |
| $ |
| $ |
| 0063 |
| Process and Finish, Acrylic Partial Denture (7 or more teeth) *VA provides teeth |
| 40 |
| EA |
| $ |
| $ |
| 0064 |
| Set-up, Process and Finish, Acrylic Partial Denture (1 -2 teeth) *VA provides teeth |
| 80 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0065 |
| Set-up, Process and Finish, Acrylic Partial Denture (3 -6 teeth) *VA provides teeth |
| 100 |
| EA |
| $ |
| $ |
| 0066 |
| Set-up, Process and Finish, Acrylic Partial Denture (7 or more teeth) *VA provides teeth |
| 40 |
| EA |
| $ |
| $ |
| 0067 |
| Cu-Sil Partial (first area) Soft Gasket |
| 1 |
| EA |
| $ |
| $ |
| 0068 |
| Cu-Sil Partial (each additional area) Soft Gasket |
| 1 |
| EA |
| $ |
| $ |
| 0069 |
| Repair, Complete Denture, Replace Denture Tooth *VA provides teeth |
| 50 |
| EA |
| $ |
| $ |
| 0070 |
| Repair, Complete Denture, Repair Acrylic Base |
| 25 |
| EA |
| $ |
| $ |
| 0071 |
| Repair, Partial Denture, Replace Denture Tooth *VA provides teeth |
| 50 |
| EA |
| $ |
| $ |
| 0072 |
| Repair, Partial Denture, Add Denture Tooth *VA provides teeth |
| 50 |
| EA |
| $ |
| $ |
| 0073 |
| Repair, Partial Denture, Replace Clasp Assembly |
| 25 |
| EA |
| $ |
| $ |
| 0074 |
| Repair, Partial Denture, Add Pre-Fabricated Clasp Assembly |
| 50 |
| EA |
| $ |
| $ |
| 0075 |
| Repair, Partial Denture, Laser Weld, Add/Replace Clasp Assembly |
| 30 |
| EA |
| $ |
| $ |
| 0076 |
| Repair, Partial Denture, Repair Acrylic Base |
| 25 |
| EA |
| $ |
| $ |
| 0077 |
| Reline, Complete Denture |
| 100 |
| EA |
| $ |
| $ |
| 0078 |
| Reline, Complete Denture, Soft Reline |
| 1 |
| EA |
| $ |
| $ |
| 0079 |
| Reline, Complete Denture, Molloplast-B Reline |
| 1 |
| EA |
| $ |
| $ |
| 0080 |
| Reline, Complete Denture, Same Day Turnaround |
| 1 |
| EA |
| $ |
| $ |
| 0081 |
| Reline, Partial Denture (1 - 6 teeth) |
| 10 |
| EA |
| $ |
| $ |
| 0082 |
| Reline, Partial Denture (7 or more teeth) |
| 10 |
| EA |
| $ |
| $ |
| 0083 |
| Rebase, Complete Denture |
| 1 |
| EA |
| $ |
| $ |
| 0084 |
| Reinforcement, Complete Denture, Pre-fabricated Mesh |
| 5 |
| EA |
| $ |
| $ |
| 0085 |
| Reinforcement, Complete Denture, Custom Cast Internal Framework |
| 2 |
| EA |
| $ |
| $ |
| 0086 |
| Wrought Wire Clasp |
| 500 |
| EA |
| $ |
| $ |
| 0087 |
| Ball Clasp |
| 50 |
| EA |
| $ |
| $ |
| 0088 |
| Name in Denture |
| 10 |
| EA |
| $ |
| $ |
| 0089 |
| Duplicate Denture (poured resin teeth) |
| 1 |
| EA |
| $ |
| $ |
| 0090 |
| Immediate Denture, Cast Surgery (1-2 teeth removed) |
| 25 |
| EA |
| $ |
| $ |
| 0091 |
| Immediate Denture, Cast Surgery (3-6 teeth removed) |
| 50 |
| EA |
| $ |
| $ |
| 0092 |
| Immediate Denture, Cast Surgery (7 or more teeth removed) |
| 25 |
| EA |
| $ |
| $ |
| 0093 |
| Custom Tray |
| 500 |
| EA |
| $ |
| $ |
| 0094 |
| Base Plate and Bite Rim |
| 500 |
| EA |
| $ |
| $ |
| 0095 |
| Model Service |
| 500 |
| EA |
| $ |
| $ |
| 0096 |
| Duplicate Model Service |
| 250 |
| EA |
| $ |
| $ |
| 0097 |
| Altered Cast Model Service |
| 10 |
| EA |
| $ |
| $ |
| 0098 |
| Articulation (for simple hinge articulators) |
| 10 |
| EA |
| $ |
| $ |
| 0099 |
| Articulation (for semi-adjustable articulators) |
| 250 |
| EA |
| $ |
| $ |
| 0100 |
| Wironium Partial Denture Framework (includes 2 clasps) |
| 135 |
| EA |
| $ |
| $ |
| 0101 |
| Wironium Unilateral Partial Denture Framework (includes 2 clasps) |
| 1 |
| EA |
| $ |
| $ |
| 0102 |
| Wironium Swing-Lock Partial Denture Framework (includes hinge/attachment components) |
| 1 |
| EA |
| $ |
| $ |
| 0103 |
| Wironium Complete Denture Cast Base |
| 1 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0104 |
| Wironium Obturator Framework |
| 1 |
| EA |
| $ |
| $ |
| 0105 |
| Additional Cast Clasp for Partial Denture Framework |
| 50 |
| EA |
| $ |
| $ |
| 0106 |
| Metal Pontic for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0107 |
| Metal Onlay for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0108 |
| Metal Backing for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0109 |
| Metal masking/Opaque for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0110 |
| Silicoating for Partial Denture Framework |
| 1 |
| EA |
| $ |
| $ |
| 0111 |
| DSE Hinge for Partial Denture Framework |
| 1 |
| EA |
| $ |
| $ |
| 0112 |
| Gold Framework for Partials *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0113 |
| Process and Finish, Flexible Partial Denture (1 -2 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0114 |
| Process and Finish, Flexible Partial Denture (3 -6 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0115 |
| Process and Finish, Flexible Partial Denture (7 or more teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0116 |
| Set-up, Process and Finish, Flexible Partial Denture (1 -2 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0117 |
| Set-up, Process and Finish, Flexible Partial Denture (3 -6 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0118 |
| Set-up, Process and Finish, Flexible Partial Denture (7 or more teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0119 |
| Denture Teeth, Dentsply Portrait IPN, Anterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0120 |
| Denture Teeth, Dentsply Portrait IPN, Anterior Teeth, Set of 6 |
| 5 |
| EA |
| $ |
| $ |
| 0121 |
| Denture Teeth, Dentsply Bioblend IPN, Anterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0122 |
| Denture Teeth, Dentsply Bioblend IPN, Anterior Teeth, Set of 6 |
| 50 |
| EA |
| $ |
| $ |
| 0123 |
| Denture Teeth, Dentsply Portrait IPN, Posterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0124 |
| Denture Teeth, Dentsply Portrait IPN, Posterior Teeth, Set of 6 |
| 5 |
| EA |
| $ |
| $ |
| 0125 |
| Denture Teeth, Dentsply Bioform IPN, Posterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0126 |
| Denture Teeth, Dentsply Bioform IPN, Posterior Teeth, Set of 6 |
| 50 |
| EA |
| $ |
| $ |
| 0127 |
| TMJ Hard Splint |
| 15 |
| EA |
| $ |
| $ |
| 0128 |
| TMJ Anterior Positioning Splint/Orthotic |
| 1 |
| EA |
| $ |
| $ |
| 0129 |
| FlexiSplint Semi-Soft Bruxism Splint |
| 60 |
| EA |
| $ |
| $ |
| 0130 |
| Hybrid Splint Hard/Soft |
| 240 |
| EA |
| $ |
| $ |
| 0131 |
| Mandibular Advancement Device, OSA, DreamTAP |
| 0 |
| EA |
| $ |
| $ |
| 0132 |
| Mandibular Advancement Device, OSA, DreamTAP-PAP |
Implant Prosthodontics (Fixed & Removable Prosthetics)
| 0133 |
| Porcelain-Fused-to-High Noble Implant Crown, Screw-Retained *Alloy billed separately, **VA provides cast-to abutment |
| 50 |
| EA |
| $ |
| $ |
| 0134 |
| Porcelain-Fused-to-Noble Implant Crown, Screw-Retained *Alloy billed separately, **VA provides cast-to abutment |
| 1 |
| EA |
| $ |
| $ |
| 0135 |
| Gold Implant Crown, High Noble, Screw-Retained *Alloy billed separately, **VA provides cast-to abutment |
| 25 |
| EA |
| $ |
| $ |
| 0136 |
| Gold Implant Crown, Noble, Screw-Retained *Alloy billed separately, **VA provides cast-to abutment |
| 1 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0137 |
| Zirconia Implant Crown, Full Contour, Screw Retained, Procera, with screw |
| 1 |
| EA |
| $ |
| $ |
| 0138 |
| Porcelain-Fused-to-Zirconia Implant Crown, Screw Retained *CAD/CAM Zirconia Abutment billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0139 |
| Porcelain-Fused-to-High Noble Implant Crown, Cement-Retained *Alloy billed separately |
| 50 |
| EA |
| $ |
| $ |
| 0140 |
| Porcelain-Fused-to-Noble Implant Crown, Cement-Retained *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0141 |
| Gold Implant Crown, High Noble, Cement-Retained *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0142 |
| Gold Implant Crown, Noble, Cement-Retained *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0143 |
| Zirconia Implant Crown, Cement-Retained |
| 25 |
| EA |
| $ |
| $ |
| 0144 |
| Zirconia w/ Layered Porcelain Implant Crown, Cement-Retained |
| 1 |
| EA |
| $ |
| $ |
| 0145 |
| Stock Abutment Modification *VA provides stock abutment |
| 10 |
| EA |
| $ |
| $ |
| 0146 |
| Custom Cast Abutment, High Noble *Alloy billed separately, **VA provides cast-to abutment |
| 10 |
| EA |
| $ |
| $ |
| 0147 |
| Custom Cast Abutment, Noble *Alloy billed separately, **VA provides cast-to abutment |
| 1 |
| EA |
| $ |
| $ |
| 0148 |
| Custom CAD/CAM Abutment, Straumann, Titanium with Screw |
| 50 |
| EA |
| $ |
| $ |
| 0149 |
| Custom CAD/CAM Abutment, Straumann, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0150 |
| Custom CAD/CAM Abutment, Procera, Titanium with Screw |
| 25 |
| EA |
| $ |
| $ |
| 0151 |
| Custom CAD/CAM Abutment, Procera, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0152 |
| Custom CAD/CAM Abutment, Atlantis, Titanium with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0153 |
| Custom CAD/CAM Abutment, Atlantis, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0154 |
| Custom CAD/CAM Abutment, BellaTek, Titanium with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0155 |
| Custom CAD/CAM Abutment, BellaTek, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0156 |
| Custom CAD/CAM Abutment, BellaTek with Encode Abutment, Titanium with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0157 |
| Custom CAD/CAM Abutment, BellaTek with Encode Abutment, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0158 |
| Fixed Detachable Hybrid Denture, Custom CAD/CAM Implant Connecting Bar (includes silicoating if needed) |
| 1 |
| EA |
| $ |
| $ |
| 0159 |
| Fixed Detachable Hybrid Denture, Set-up for Try-in *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0160 |
| Fixed Detachable Hybrid Denture, Process and Finish (Processed with Lucitone 199 per Rx) |
| 1 |
| EA |
| $ |
| $ |
| 0161 |
| Fixed Detachable Zirconia Bridge, Custom CAD/CAM Zirconia Framework/Structure (for use in full-arch restorations or when soft and hard tissue are being restored in a multi-unit FDP) |
| 1 |
| EA |
| $ |
| $ |
| 0162 |
| Bar Supported Overdenture, Custom CAD/CAM Implant Connecting Bar *VA provides prosthetic attachments |
| 1 |
| EA |
| $ |
| $ |
| 0163 |
| Bar Supported Overdenture, Wironium Super Structure Framework |
| 1 |
| EA |
| $ |
| $ |
| 0164 |
| Bar Supported Overdenture, Set-up for Try-in *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0165 |
| Bar Supported Overdenture, Process and Finish (Processed with Lucitone 199 per Rx) |
| 1 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0166 |
| Implant Retained Overdenture, Wironium Internal/External Framework |
| 5 |
| EA |
| $ |
| $ |
| 0167 |
| Implant Retained Overdenture, Cast Mesh Reinforcement |
| 5 |
| EA |
| $ |
| $ |
| 0168 |
| Implant Retained Overdenture, Set-up for Try-in *VA provides teeth |
| 25 |
| EA |
| $ |
| $ |
| 0169 |
| Implant Retained Overdenture, Process and Finish (Processed with Lucitone 199 per Rx) |
| 25 |
| EA |
| $ |
| $ |
| 0170 |
| Implant Attachment Pick-up by Laboratory, per attachment *VA provides prosthetic attachment |
| 50 |
| EA |
| $ |
| $ |
| 0171 |
| Surgical Stent with Guide Holes (Diagnostic Wax-up billed separately) |
| 50 |
| EA |
| $ |
| $ |
| 0172 |
| Surgical Stent with Barium Coating (Diagnostic Wax-up billed separately) |
| 1 |
| EA |
| $ |
| $ |
| 0173 |
| Implant Custom Tray |
| 150 |
| EA |
| $ |
| $ |
| 0174 |
| Implant Model Service with Soft Tissue Insert *VA provides implant/abutment analog |
| 100 |
| EA |
| $ |
| $ |
| 0175 |
| Implant Model Service from Stage One Surgery *VA provides implant/abutment analog |
| 1 |
| EA |
| $ |
| $ |
| 0176 |
| Abutment Position Verification Jig |
| 1 |
| EA |
| $ |
| $ |
| 0177 |
| Articulation (for simple hinge articulators) |
| 10 |
| EA |
| $ |
| $ |
| 0178 |
| Articulation (for semi-adjustable articulators) |
| 150 |
| EA |
| $ |
| $ |
| 0179 |
| Abutment Placement Jig |
| 150 |
| EA |
| $ |
| $ |
| 0180 |
| Diagnostic Wax-up |
| 50 |
| EA |
| $ |
| $ |
| 0181 |
| Duplicate Model Service |
| 50 |
| EA |
| $ |
| $ |
| 0182 |
| Radica Implant Crown, Screw Retained (Diagnostic Wax-up billed separeately) *VA provides temporary abutment |
| 25 |
| EA |
| $ |
| $ |
| 0183 |
| Implant Torch Wrench Kit (per usage) |
| 10 |
| EA |
| $ |
| $ |
| 0184 |
| Alloy Estimate for High Noble Gold Implant Crowns *Changes with Gold Market |
| 400 |
| GRAM |
| $ |
| $ |
| 0185 |
| Alloy Estimate for Noble Gold Implant Crowns *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
| 0186 |
| Alloy Estimate for High Noble PFM Implant Crowns *Changes with Gold Market |
| 700 |
| GRAM |
| $ |
| $ |
| 0187 |
| Alloy Estimate for Noble PFM Implant Crowns *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
DENTAL LAB SERVICES FOR Rocky Mountain Regional VA Medical Center OPTION YEAR #2: October 1, 2022 through September 30, 2023
QUANTITIES
COST
TOTAL
COST
Conventional Fixed Prosthodontics (Crown & Bridge)
| 0001 |
| Full Cast Crown/Pontic, High Noble Alloy *Alloy billed separately |
| 350 |
| EA |
| $ |
| $ |
| 0002 |
| Cast Inlay/Onlay/Multi-Surface, High Noble Alloy *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0003 |
| Full Cast Crown/Pontic, Noble Alloy *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0004 |
| Cast Inlay/Onlay/Multi-Surface, Noble Alloy *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0005 |
| Porcelain-Fused-to-High Noble Crown/Pontic *Alloy billed separately |
| 550 |
| EA |
| $ |
| $ |
| 0006 |
| Porcelain-Fused-to-Noble Crown/Pontic *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0007 |
| Full Contour Zirconia Crown/Pontic |
| 50 |
| EA |
| $ |
| $ |
| 0008 |
| Zirconia w/ Layered Porcelain Crown/Pontic |
| 20 |
| EA |
| $ |
| $ |
| 0009 |
| Porcelain-Fused-to-Alumina Crown/Pontic |
| 1 |
| EA |
| $ |
| $ |
| 0010 |
| Lithium Disilicate Pressed Crown/Pontic |
| 50 |
| EA |
| $ |
| $ |
| 0011 |
| Lithium Disilicate Pressed w/ Layered Porcelain Crown/Pontic |
| 10 |
| EA |
| $ |
| $ |
| 0012 |
| Lithium Disilicate Pressed Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0013 |
| Leucite Glass-Ceramic Pressed Crown |
| 1 |
| EA |
| $ |
| $ |
| 0014 |
| Leucite Glass-Ceramic Pressed Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0015 |
| [Layered Composite Services] Ceramage Crown/Pontic |
| 1 |
| EA |
| $ |
| $ |
| 0016 |
| [Layered Composite Services] Ceramage Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0017 |
| [Layered Composite Services] Ceramage FibreKor Maryland Bridge (includes one pontic) |
| 1 |
| EA |
| $ |
| $ |
| 0018 |
| [Layered Composite Services] Radica Crown/Pontic |
| 1 |
| EA |
| $ |
| $ |
| 0019 |
| [Layered Composite Services] Radica Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0020 |
| Layered Porcelain Veneer-Feldspathic (refractory technique) |
| 1 |
| EA |
| $ |
| $ |
| 0021 |
| [Maryland Bridge] Pontic (includes one model and die) |
| 1 |
| EA |
| $ |
| $ |
| 0022 |
| [Maryland Bridge] Wing (includes one model and die) |
| 2 |
| EA |
| $ |
| $ |
| 0023 |
| Provisional Temporary Crown/Pontic (Diagnostic Wax-up billed separately) |
| 40 |
| EA |
| $ |
| $ |
| 0024 |
| Custom Tray |
| 350 |
| EA |
| $ |
| $ |
| 0025 |
| Diagnostic Wax-up |
| 540 |
| EA |
| $ |
| $ |
| 0026 |
| Provisional Stent |
| 350 |
| EA |
| $ |
| $ |
| 0027 |
| Model Service |
| 1100 |
| EA |
| $ |
| $ |
| 0028 |
| Epoxy Model Service |
| 1 |
| EA |
| $ |
| $ |
| 0029 |
| Die Service |
| 550 |
| EA |
| $ |
| $ |
| 0030 |
| Duplicate Model Service |
| 175 |
| EA |
| $ |
| $ |
| 0031 |
| Articulation (for simple hinge articulators) |
| 775 |
| EA |
| $ |
| $ |
| 0032 |
| Articulation (for semi-adjustable articulators) |
| 275 |
| EA |
| $ |
| $ |
| 0033 |
| Articulation with Face Bow (for semi-adjustable articulators) |
| 50 |
| EA |
| $ |
| $ |
| 0034 |
| Porcelain Shoulder |
| 150 |
| EA |
| $ |
| $ |
| 0035 |
| Metal Occlusal |
| 100 |
| EA |
| $ |
| $ |
| 0036 |
| Design Crown for Partial |
| 100 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0037 |
| Fit to Existing Partial |
| 5 |
| EA |
| $ |
| $ |
| 0038 |
| Bridge Connector |
| 325 |
| EA |
| $ |
| $ |
| 0039 |
| Stress Breaker |
| 1 |
| EA |
| $ |
| $ |
| 0040 |
| Custom Shade (Includes two appointment process) |
| 5 |
| EA |
| $ |
| $ |
| 0041 |
| Rush Fee (per unit) |
| 5 |
| EA |
| $ |
| $ |
| 0042 |
| Cast Post & Core *Alloy billed separately |
| 12 |
| EA |
| $ |
| $ |
| 0043 |
| Laser Weld FDP Framework |
| 1 |
| EA |
| $ |
| $ |
| 0044 |
| Solder FDP Framework |
| 1 |
| EA |
| $ |
| $ |
| 0045 |
| Add Porcelain Contact |
| 10 |
| EA |
| $ |
| $ |
| 0046 |
| Add Solder Contact |
| 10 |
| EA |
| $ |
| $ |
| 0047 |
| Reduction Coping Resin |
| 20 |
| EA |
| $ |
| $ |
| 0048 |
| Alloy Estimate for High Noble Gold Crowns/Pontics/Inlays/Onlays *Changes with Gold Market |
| 750 |
| GRAM |
| $ |
| $ |
| 0049 |
| Alloy Estimate for Noble Gold Crowns/Pontics/Inlays/Onlays *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
| 0050 |
| Alloy Estimate for High Noble PFM Crowns/Pontics *Changes with Gold Market |
| 1300 |
| GRAM |
| $ |
| $ |
| 0051 |
| Alloy Estimate for Noble PFM Crowns/Pontics *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
Conventional Removable Prosthodontic
| 0052 |
| Process and Finish, Complete Denture, Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 90 |
| EA |
| $ |
| $ |
| 0053 |
| Process and Finish, Complete Denture, Heat Processed, Injection Moulded (Processed w/ Ivocap per Rx) |
| 10 |
| EA |
| $ |
| $ |
| 0054 |
| Set-Up for Try-In, Complete Denture *VA provides teeth |
| 210 |
| EA |
| $ |
| $ |
| 0055 |
| Process and Finish, Cast Framework Partial Denture (1-2 teeth), Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 5 |
| EA |
| $ |
| $ |
| 0056 |
| Process and Finish, Cast Framework Partial Denture (3-6 teeth), Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 15 |
| EA |
| $ |
| $ |
| 0057 |
| Process and Finish, Cast Framework Partial Denture (7 or more teeth), Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 30 |
| EA |
| $ |
| $ |
| 0058 |
| Set-Up for Try-In, Partial Denture (1 - 2 teeth) *VA provides teeth |
| 5 |
| EA |
| $ |
| $ |
| 0059 |
| Set-Up for Try-In, Partial Denture (3 - 6 teeth) *VA provides teeth |
| 40 |
| EA |
| $ |
| $ |
| 0060 |
| Set-Up for Try-In, Partial Denture (7 or more teeth) *VA provides teeth |
| 110 |
| EA |
| $ |
| $ |
| 0061 |
| Process and Finish, Acrylic Partial Denture (1 -2 teeth) *VA provides teeth |
| 80 |
| EA |
| $ |
| $ |
| 0062 |
| Process and Finish, Acrylic Partial Denture (3 -6 teeth) *VA provides teeth |
| 100 |
| EA |
| $ |
| $ |
| 0063 |
| Process and Finish, Acrylic Partial Denture (7 or more teeth) *VA provides teeth |
| 40 |
| EA |
| $ |
| $ |
| 0064 |
| Set-up, Process and Finish, Acrylic Partial Denture (1 -2 teeth) *VA provides teeth |
| 80 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0065 |
| Set-up, Process and Finish, Acrylic Partial Denture (3 -6 teeth) *VA provides teeth |
| 100 |
| EA |
| $ |
| $ |
| 0066 |
| Set-up, Process and Finish, Acrylic Partial Denture (7 or more teeth) *VA provides teeth |
| 40 |
| EA |
| $ |
| $ |
| 0067 |
| Cu-Sil Partial (first area) Soft Gasket |
| 1 |
| EA |
| $ |
| $ |
| 0068 |
| Cu-Sil Partial (each additional area) Soft Gasket |
| 1 |
| EA |
| $ |
| $ |
| 0069 |
| Repair, Complete Denture, Replace Denture Tooth *VA provides teeth |
| 50 |
| EA |
| $ |
| $ |
| 0070 |
| Repair, Complete Denture, Repair Acrylic Base |
| 25 |
| EA |
| $ |
| $ |
| 0071 |
| Repair, Partial Denture, Replace Denture Tooth *VA provides teeth |
| 50 |
| EA |
| $ |
| $ |
| 0072 |
| Repair, Partial Denture, Add Denture Tooth *VA provides teeth |
| 50 |
| EA |
| $ |
| $ |
| 0073 |
| Repair, Partial Denture, Replace Clasp Assembly |
| 25 |
| EA |
| $ |
| $ |
| 0074 |
| Repair, Partial Denture, Add Pre-Fabricated Clasp Assembly |
| 50 |
| EA |
| $ |
| $ |
| 0075 |
| Repair, Partial Denture, Laser Weld, Add/Replace Clasp Assembly |
| 30 |
| EA |
| $ |
| $ |
| 0076 |
| Repair, Partial Denture, Repair Acrylic Base |
| 25 |
| EA |
| $ |
| $ |
| 0077 |
| Reline, Complete Denture |
| 100 |
| EA |
| $ |
| $ |
| 0078 |
| Reline, Complete Denture, Soft Reline |
| 1 |
| EA |
| $ |
| $ |
| 0079 |
| Reline, Complete Denture, Molloplast-B Reline |
| 1 |
| EA |
| $ |
| $ |
| 0080 |
| Reline, Complete Denture, Same Day Turnaround |
| 1 |
| EA |
| $ |
| $ |
| 0081 |
| Reline, Partial Denture (1 - 6 teeth) |
| 10 |
| EA |
| $ |
| $ |
| 0082 |
| Reline, Partial Denture (7 or more teeth) |
| 10 |
| EA |
| $ |
| $ |
| 0083 |
| Rebase, Complete Denture |
| 1 |
| EA |
| $ |
| $ |
| 0084 |
| Reinforcement, Complete Denture, Pre-fabricated Mesh |
| 5 |
| EA |
| $ |
| $ |
| 0085 |
| Reinforcement, Complete Denture, Custom Cast Internal Framework |
| 2 |
| EA |
| $ |
| $ |
| 0086 |
| Wrought Wire Clasp |
| 500 |
| EA |
| $ |
| $ |
| 0087 |
| Ball Clasp |
| 50 |
| EA |
| $ |
| $ |
| 0088 |
| Name in Denture |
| 10 |
| EA |
| $ |
| $ |
| 0089 |
| Duplicate Denture (poured resin teeth) |
| 1 |
| EA |
| $ |
| $ |
| 0090 |
| Immediate Denture, Cast Surgery (1-2 teeth removed) |
| 25 |
| EA |
| $ |
| $ |
| 0091 |
| Immediate Denture, Cast Surgery (3-6 teeth removed) |
| 50 |
| EA |
| $ |
| $ |
| 0092 |
| Immediate Denture, Cast Surgery (7 or more teeth removed) |
| 25 |
| EA |
| $ |
| $ |
| 0093 |
| Custom Tray |
| 500 |
| EA |
| $ |
| $ |
| 0094 |
| Base Plate and Bite Rim |
| 500 |
| EA |
| $ |
| $ |
| 0095 |
| Model Service |
| 500 |
| EA |
| $ |
| $ |
| 0096 |
| Duplicate Model Service |
| 250 |
| EA |
| $ |
| $ |
| 0097 |
| Altered Cast Model Service |
| 10 |
| EA |
| $ |
| $ |
| 0098 |
| Articulation (for simple hinge articulators) |
| 10 |
| EA |
| $ |
| $ |
| 0099 |
| Articulation (for semi-adjustable articulators) |
| 250 |
| EA |
| $ |
| $ |
| 0100 |
| Wironium Partial Denture Framework (includes 2 clasps) |
| 135 |
| EA |
| $ |
| $ |
| 0101 |
| Wironium Unilateral Partial Denture Framework (includes 2 clasps) |
| 1 |
| EA |
| $ |
| $ |
| 0102 |
| Wironium Swing-Lock Partial Denture Framework (includes hinge/attachment components) |
| 1 |
| EA |
| $ |
| $ |
| 0103 |
| Wironium Complete Denture Cast Base |
| 1 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0104 |
| Wironium Obturator Framework |
| 1 |
| EA |
| $ |
| $ |
| 0105 |
| Additional Cast Clasp for Partial Denture Framework |
| 50 |
| EA |
| $ |
| $ |
| 0106 |
| Metal Pontic for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0107 |
| Metal Onlay for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0108 |
| Metal Backing for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0109 |
| Metal masking/Opaque for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0110 |
| Silicoating for Partial Denture Framework |
| 1 |
| EA |
| $ |
| $ |
| 0111 |
| DSE Hinge for Partial Denture Framework |
| 1 |
| EA |
| $ |
| $ |
| 0112 |
| Gold Framework for Partials *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0113 |
| Process and Finish, Flexible Partial Denture (1 -2 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0114 |
| Process and Finish, Flexible Partial Denture (3 -6 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0115 |
| Process and Finish, Flexible Partial Denture (7 or more teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0116 |
| Set-up, Process and Finish, Flexible Partial Denture (1 -2 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0117 |
| Set-up, Process and Finish, Flexible Partial Denture (3 -6 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0118 |
| Set-up, Process and Finish, Flexible Partial Denture (7 or more teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0119 |
| Denture Teeth, Dentsply Portrait IPN, Anterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0120 |
| Denture Teeth, Dentsply Portrait IPN, Anterior Teeth, Set of 6 |
| 5 |
| EA |
| $ |
| $ |
| 0121 |
| Denture Teeth, Dentsply Bioblend IPN, Anterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0122 |
| Denture Teeth, Dentsply Bioblend IPN, Anterior Teeth, Set of 6 |
| 50 |
| EA |
| $ |
| $ |
| 0123 |
| Denture Teeth, Dentsply Portrait IPN, Posterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0124 |
| Denture Teeth, Dentsply Portrait IPN, Posterior Teeth, Set of 6 |
| 5 |
| EA |
| $ |
| $ |
| 0125 |
| Denture Teeth, Dentsply Bioform IPN, Posterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0126 |
| Denture Teeth, Dentsply Bioform IPN, Posterior Teeth, Set of 6 |
| 50 |
| EA |
| $ |
| $ |
| 0127 |
| TMJ Hard Splint |
| 15 |
| EA |
| $ |
| $ |
| 0128 |
| TMJ Anterior Positioning Splint/Orthotic |
| 1 |
| EA |
| $ |
| $ |
| 0129 |
| FlexiSplint Semi-Soft Bruxism Splint |
| 60 |
| EA |
| $ |
| $ |
| 0130 |
| Hybrid Splint Hard/Soft |
| 240 |
| EA |
| $ |
| $ |
| 0131 |
| Mandibular Advancement Device, OSA, DreamTAP |
| 0 |
| EA |
| $ |
| $ |
| 0132 |
| Mandibular Advancement Device, OSA, DreamTAP-PAP |
Implant Prosthodontics (Fixed & Removable Prosthetics)
| 0133 |
| Porcelain-Fused-to-High Noble Implant Crown, Screw-Retained *Alloy billed separately, **VA provides cast-to abutment |
| 50 |
| EA |
| $ |
| $ |
| 0134 |
| Porcelain-Fused-to-Noble Implant Crown, Screw-Retained *Alloy billed separately, **VA provides cast-to abutment |
| 1 |
| EA |
| $ |
| $ |
| 0135 |
| Gold Implant Crown, High Noble, Screw-Retained *Alloy billed separately, **VA provides cast-to abutment |
| 25 |
| EA |
| $ |
| $ |
| 0136 |
| Gold Implant Crown, Noble, Screw-Retained *Alloy billed separately, **VA provides cast-to abutment |
| 1 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0137 |
| Zirconia Implant Crown, Full Contour, Screw Retained, Procera, with screw |
| 1 |
| EA |
| $ |
| $ |
| 0138 |
| Porcelain-Fused-to-Zirconia Implant Crown, Screw Retained *CAD/CAM Zirconia Abutment billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0139 |
| Porcelain-Fused-to-High Noble Implant Crown, Cement-Retained *Alloy billed separately |
| 50 |
| EA |
| $ |
| $ |
| 0140 |
| Porcelain-Fused-to-Noble Implant Crown, Cement-Retained *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0141 |
| Gold Implant Crown, High Noble, Cement-Retained *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0142 |
| Gold Implant Crown, Noble, Cement-Retained *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0143 |
| Zirconia Implant Crown, Cement-Retained |
| 25 |
| EA |
| $ |
| $ |
| 0144 |
| Zirconia w/ Layered Porcelain Implant Crown, Cement-Retained |
| 1 |
| EA |
| $ |
| $ |
| 0145 |
| Stock Abutment Modification *VA provides stock abutment |
| 10 |
| EA |
| $ |
| $ |
| 0146 |
| Custom Cast Abutment, High Noble *Alloy billed separately, **VA provides cast-to abutment |
| 10 |
| EA |
| $ |
| $ |
| 0147 |
| Custom Cast Abutment, Noble *Alloy billed separately, **VA provides cast-to abutment |
| 1 |
| EA |
| $ |
| $ |
| 0148 |
| Custom CAD/CAM Abutment, Straumann, Titanium with Screw |
| 50 |
| EA |
| $ |
| $ |
| 0149 |
| Custom CAD/CAM Abutment, Straumann, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0150 |
| Custom CAD/CAM Abutment, Procera, Titanium with Screw |
| 25 |
| EA |
| $ |
| $ |
| 0151 |
| Custom CAD/CAM Abutment, Procera, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0152 |
| Custom CAD/CAM Abutment, Atlantis, Titanium with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0153 |
| Custom CAD/CAM Abutment, Atlantis, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0154 |
| Custom CAD/CAM Abutment, BellaTek, Titanium with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0155 |
| Custom CAD/CAM Abutment, BellaTek, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0156 |
| Custom CAD/CAM Abutment, BellaTek with Encode Abutment, Titanium with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0157 |
| Custom CAD/CAM Abutment, BellaTek with Encode Abutment, Zirconia with Screw |
| 1 |
| EA |
| $ |
| $ |
| 0158 |
| Fixed Detachable Hybrid Denture, Custom CAD/CAM Implant Connecting Bar (includes silicoating if needed) |
| 1 |
| EA |
| $ |
| $ |
| 0159 |
| Fixed Detachable Hybrid Denture, Set-up for Try-in *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0160 |
| Fixed Detachable Hybrid Denture, Process and Finish (Processed with Lucitone 199 per Rx) |
| 1 |
| EA |
| $ |
| $ |
| 0161 |
| Fixed Detachable Zirconia Bridge, Custom CAD/CAM Zirconia Framework/Structure (for use in full-arch restorations or when soft and hard tissue are being restored in a multi-unit FDP) |
| 1 |
| EA |
| $ |
| $ |
| 0162 |
| Bar Supported Overdenture, Custom CAD/CAM Implant Connecting Bar *VA provides prosthetic attachments |
| 1 |
| EA |
| $ |
| $ |
| 0163 |
| Bar Supported Overdenture, Wironium Super Structure Framework |
| 1 |
| EA |
| $ |
| $ |
| 0164 |
| Bar Supported Overdenture, Set-up for Try-in *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0165 |
| Bar Supported Overdenture, Process and Finish (Processed with Lucitone 199 per Rx) |
| 1 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0166 |
| Implant Retained Overdenture, Wironium Internal/External Framework |
| 5 |
| EA |
| $ |
| $ |
| 0167 |
| Implant Retained Overdenture, Cast Mesh Reinforcement |
| 5 |
| EA |
| $ |
| $ |
| 0168 |
| Implant Retained Overdenture, Set-up for Try-in *VA provides teeth |
| 25 |
| EA |
| $ |
| $ |
| 0169 |
| Implant Retained Overdenture, Process and Finish (Processed with Lucitone 199 per Rx) |
| 25 |
| EA |
| $ |
| $ |
| 0170 |
| Implant Attachment Pick-up by Laboratory, per attachment *VA provides prosthetic attachment |
| 50 |
| EA |
| $ |
| $ |
| 0171 |
| Surgical Stent with Guide Holes (Diagnostic Wax-up billed separately) |
| 50 |
| EA |
| $ |
| $ |
| 0172 |
| Surgical Stent with Barium Coating (Diagnostic Wax-up billed separately) |
| 1 |
| EA |
| $ |
| $ |
| 0173 |
| Implant Custom Tray |
| 150 |
| EA |
| $ |
| $ |
| 0174 |
| Implant Model Service with Soft Tissue Insert *VA provides implant/abutment analog |
| 100 |
| EA |
| $ |
| $ |
| 0175 |
| Implant Model Service from Stage One Surgery *VA provides implant/abutment analog |
| 1 |
| EA |
| $ |
| $ |
| 0176 |
| Abutment Position Verification Jig |
| 1 |
| EA |
| $ |
| $ |
| 0177 |
| Articulation (for simple hinge articulators) |
| 10 |
| EA |
| $ |
| $ |
| 0178 |
| Articulation (for semi-adjustable articulators) |
| 150 |
| EA |
| $ |
| $ |
| 0179 |
| Abutment Placement Jig |
| 150 |
| EA |
| $ |
| $ |
| 0180 |
| Diagnostic Wax-up |
| 50 |
| EA |
| $ |
| $ |
| 0181 |
| Duplicate Model Service |
| 50 |
| EA |
| $ |
| $ |
| 0182 |
| Radica Implant Crown, Screw Retained (Diagnostic Wax-up billed separeately) *VA provides temporary abutment |
| 25 |
| EA |
| $ |
| $ |
| 0183 |
| Implant Torch Wrench Kit (per usage) |
| 10 |
| EA |
| $ |
| $ |
| 0184 |
| Alloy Estimate for High Noble Gold Implant Crowns *Changes with Gold Market |
| 400 |
| GRAM |
| $ |
| $ |
| 0185 |
| Alloy Estimate for Noble Gold Implant Crowns *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
| 0186 |
| Alloy Estimate for High Noble PFM Implant Crowns *Changes with Gold Market |
| 700 |
| GRAM |
| $ |
| $ |
| 0187 |
| Alloy Estimate for Noble PFM Implant Crowns *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
DENTAL LAB SERVICES FOR Rocky Mountain Regional VA Medical Center OPTION YEAR #3: October 1, 2023 through September 30, 2024
QUANTITIES
COST
TOTAL
COST
Conventional Fixed Prosthodontics (Crown & Bridge)
| 0001 |
| Full Cast Crown/Pontic, High Noble Alloy *Alloy billed separately |
| 350 |
| EA |
| $ |
| $ |
| 0002 |
| Cast Inlay/Onlay/Multi-Surface, High Noble Alloy *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0003 |
| Full Cast Crown/Pontic, Noble Alloy *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0004 |
| Cast Inlay/Onlay/Multi-Surface, Noble Alloy *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0005 |
| Porcelain-Fused-to-High Noble Crown/Pontic *Alloy billed separately |
| 550 |
| EA |
| $ |
| $ |
| 0006 |
| Porcelain-Fused-to-Noble Crown/Pontic *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0007 |
| Full Contour Zirconia Crown/Pontic |
| 50 |
| EA |
| $ |
| $ |
| 0008 |
| Zirconia w/ Layered Porcelain Crown/Pontic |
| 20 |
| EA |
| $ |
| $ |
| 0009 |
| Porcelain-Fused-to-Alumina Crown/Pontic |
| 1 |
| EA |
| $ |
| $ |
| 0010 |
| Lithium Disilicate Pressed Crown/Pontic |
| 50 |
| EA |
| $ |
| $ |
| 0011 |
| Lithium Disilicate Pressed w/ Layered Porcelain Crown/Pontic |
| 10 |
| EA |
| $ |
| $ |
| 0012 |
| Lithium Disilicate Pressed Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0013 |
| Leucite Glass-Ceramic Pressed Crown |
| 1 |
| EA |
| $ |
| $ |
| 0014 |
| Leucite Glass-Ceramic Pressed Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0015 |
| [Layered Composite Services] Ceramage Crown/Pontic |
| 1 |
| EA |
| $ |
| $ |
| 0016 |
| [Layered Composite Services] Ceramage Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0017 |
| [Layered Composite Services] Ceramage FibreKor Maryland Bridge (includes one pontic) |
| 1 |
| EA |
| $ |
| $ |
| 0018 |
| [Layered Composite Services] Radica Crown/Pontic |
| 1 |
| EA |
| $ |
| $ |
| 0019 |
| [Layered Composite Services] Radica Inlay/Onlay |
| 1 |
| EA |
| $ |
| $ |
| 0020 |
| Layered Porcelain Veneer-Feldspathic (refractory technique) |
| 1 |
| EA |
| $ |
| $ |
| 0021 |
| [Maryland Bridge] Pontic (includes one model and die) |
| 1 |
| EA |
| $ |
| $ |
| 0022 |
| [Maryland Bridge] Wing (includes one model and die) |
| 2 |
| EA |
| $ |
| $ |
| 0023 |
| Provisional Temporary Crown/Pontic (Diagnostic Wax-up billed separately) |
| 40 |
| EA |
| $ |
| $ |
| 0024 |
| Custom Tray |
| 350 |
| EA |
| $ |
| $ |
| 0025 |
| Diagnostic Wax-up |
| 540 |
| EA |
| $ |
| $ |
| 0026 |
| Provisional Stent |
| 350 |
| EA |
| $ |
| $ |
| 0027 |
| Model Service |
| 1100 |
| EA |
| $ |
| $ |
| 0028 |
| Epoxy Model Service |
| 1 |
| EA |
| $ |
| $ |
| 0029 |
| Die Service |
| 550 |
| EA |
| $ |
| $ |
| 0030 |
| Duplicate Model Service |
| 175 |
| EA |
| $ |
| $ |
| 0031 |
| Articulation (for simple hinge articulators) |
| 775 |
| EA |
| $ |
| $ |
| 0032 |
| Articulation (for semi-adjustable articulators) |
| 275 |
| EA |
| $ |
| $ |
| 0033 |
| Articulation with Face Bow (for semi-adjustable articulators) |
| 50 |
| EA |
| $ |
| $ |
| 0034 |
| Porcelain Shoulder |
| 150 |
| EA |
| $ |
| $ |
| 0035 |
| Metal Occlusal |
| 100 |
| EA |
| $ |
| $ |
| 0036 |
| Design Crown for Partial |
| 100 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0037 |
| Fit to Existing Partial |
| 5 |
| EA |
| $ |
| $ |
| 0038 |
| Bridge Connector |
| 325 |
| EA |
| $ |
| $ |
| 0039 |
| Stress Breaker |
| 1 |
| EA |
| $ |
| $ |
| 0040 |
| Custom Shade (Includes two appointment process) |
| 5 |
| EA |
| $ |
| $ |
| 0041 |
| Rush Fee (per unit) |
| 5 |
| EA |
| $ |
| $ |
| 0042 |
| Cast Post & Core *Alloy billed separately |
| 12 |
| EA |
| $ |
| $ |
| 0043 |
| Laser Weld FDP Framework |
| 1 |
| EA |
| $ |
| $ |
| 0044 |
| Solder FDP Framework |
| 1 |
| EA |
| $ |
| $ |
| 0045 |
| Add Porcelain Contact |
| 10 |
| EA |
| $ |
| $ |
| 0046 |
| Add Solder Contact |
| 10 |
| EA |
| $ |
| $ |
| 0047 |
| Reduction Coping Resin |
| 20 |
| EA |
| $ |
| $ |
| 0048 |
| Alloy Estimate for High Noble Gold Crowns/Pontics/Inlays/Onlays *Changes with Gold Market |
| 750 |
| GRAM |
| $ |
| $ |
| 0049 |
| Alloy Estimate for Noble Gold Crowns/Pontics/Inlays/Onlays *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
| 0050 |
| Alloy Estimate for High Noble PFM Crowns/Pontics *Changes with Gold Market |
| 1300 |
| GRAM |
| $ |
| $ |
| 0051 |
| Alloy Estimate for Noble PFM Crowns/Pontics *Changes with Gold Market |
| 5 |
| GRAM |
| $ |
| $ |
Conventional Removable Prosthodontic
| 0052 |
| Process and Finish, Complete Denture, Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 90 |
| EA |
| $ |
| $ |
| 0053 |
| Process and Finish, Complete Denture, Heat Processed, Injection Moulded (Processed w/ Ivocap per Rx) |
| 10 |
| EA |
| $ |
| $ |
| 0054 |
| Set-Up for Try-In, Complete Denture *VA provides teeth |
| 210 |
| EA |
| $ |
| $ |
| 0055 |
| Process and Finish, Cast Framework Partial Denture (1-2 teeth), Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 5 |
| EA |
| $ |
| $ |
| 0056 |
| Process and Finish, Cast Framework Partial Denture (3-6 teeth), Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 15 |
| EA |
| $ |
| $ |
| 0057 |
| Process and Finish, Cast Framework Partial Denture (7 or more teeth), Heat Processed, Compression Moulded (Processed w/ Lucitone 199 per Rx) |
| 30 |
| EA |
| $ |
| $ |
| 0058 |
| Set-Up for Try-In, Partial Denture (1 - 2 teeth) *VA provides teeth |
| 5 |
| EA |
| $ |
| $ |
| 0059 |
| Set-Up for Try-In, Partial Denture (3 - 6 teeth) *VA provides teeth |
| 40 |
| EA |
| $ |
| $ |
| 0060 |
| Set-Up for Try-In, Partial Denture (7 or more teeth) *VA provides teeth |
| 110 |
| EA |
| $ |
| $ |
| 0061 |
| Process and Finish, Acrylic Partial Denture (1 -2 teeth) *VA provides teeth |
| 80 |
| EA |
| $ |
| $ |
| 0062 |
| Process and Finish, Acrylic Partial Denture (3 -6 teeth) *VA provides teeth |
| 100 |
| EA |
| $ |
| $ |
| 0063 |
| Process and Finish, Acrylic Partial Denture (7 or more teeth) *VA provides teeth |
| 40 |
| EA |
| $ |
| $ |
| 0064 |
| Set-up, Process and Finish, Acrylic Partial Denture (1 -2 teeth) *VA provides teeth |
| 80 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0065 |
| Set-up, Process and Finish, Acrylic Partial Denture (3 -6 teeth) *VA provides teeth |
| 100 |
| EA |
| $ |
| $ |
| 0066 |
| Set-up, Process and Finish, Acrylic Partial Denture (7 or more teeth) *VA provides teeth |
| 40 |
| EA |
| $ |
| $ |
| 0067 |
| Cu-Sil Partial (first area) Soft Gasket |
| 1 |
| EA |
| $ |
| $ |
| 0068 |
| Cu-Sil Partial (each additional area) Soft Gasket |
| 1 |
| EA |
| $ |
| $ |
| 0069 |
| Repair, Complete Denture, Replace Denture Tooth *VA provides teeth |
| 50 |
| EA |
| $ |
| $ |
| 0070 |
| Repair, Complete Denture, Repair Acrylic Base |
| 25 |
| EA |
| $ |
| $ |
| 0071 |
| Repair, Partial Denture, Replace Denture Tooth *VA provides teeth |
| 50 |
| EA |
| $ |
| $ |
| 0072 |
| Repair, Partial Denture, Add Denture Tooth *VA provides teeth |
| 50 |
| EA |
| $ |
| $ |
| 0073 |
| Repair, Partial Denture, Replace Clasp Assembly |
| 25 |
| EA |
| $ |
| $ |
| 0074 |
| Repair, Partial Denture, Add Pre-Fabricated Clasp Assembly |
| 50 |
| EA |
| $ |
| $ |
| 0075 |
| Repair, Partial Denture, Laser Weld, Add/Replace Clasp Assembly |
| 30 |
| EA |
| $ |
| $ |
| 0076 |
| Repair, Partial Denture, Repair Acrylic Base |
| 25 |
| EA |
| $ |
| $ |
| 0077 |
| Reline, Complete Denture |
| 100 |
| EA |
| $ |
| $ |
| 0078 |
| Reline, Complete Denture, Soft Reline |
| 1 |
| EA |
| $ |
| $ |
| 0079 |
| Reline, Complete Denture, Molloplast-B Reline |
| 1 |
| EA |
| $ |
| $ |
| 0080 |
| Reline, Complete Denture, Same Day Turnaround |
| 1 |
| EA |
| $ |
| $ |
| 0081 |
| Reline, Partial Denture (1 - 6 teeth) |
| 10 |
| EA |
| $ |
| $ |
| 0082 |
| Reline, Partial Denture (7 or more teeth) |
| 10 |
| EA |
| $ |
| $ |
| 0083 |
| Rebase, Complete Denture |
| 1 |
| EA |
| $ |
| $ |
| 0084 |
| Reinforcement, Complete Denture, Pre-fabricated Mesh |
| 5 |
| EA |
| $ |
| $ |
| 0085 |
| Reinforcement, Complete Denture, Custom Cast Internal Framework |
| 2 |
| EA |
| $ |
| $ |
| 0086 |
| Wrought Wire Clasp |
| 500 |
| EA |
| $ |
| $ |
| 0087 |
| Ball Clasp |
| 50 |
| EA |
| $ |
| $ |
| 0088 |
| Name in Denture |
| 10 |
| EA |
| $ |
| $ |
| 0089 |
| Duplicate Denture (poured resin teeth) |
| 1 |
| EA |
| $ |
| $ |
| 0090 |
| Immediate Denture, Cast Surgery (1-2 teeth removed) |
| 25 |
| EA |
| $ |
| $ |
| 0091 |
| Immediate Denture, Cast Surgery (3-6 teeth removed) |
| 50 |
| EA |
| $ |
| $ |
| 0092 |
| Immediate Denture, Cast Surgery (7 or more teeth removed) |
| 25 |
| EA |
| $ |
| $ |
| 0093 |
| Custom Tray |
| 500 |
| EA |
| $ |
| $ |
| 0094 |
| Base Plate and Bite Rim |
| 500 |
| EA |
| $ |
| $ |
| 0095 |
| Model Service |
| 500 |
| EA |
| $ |
| $ |
| 0096 |
| Duplicate Model Service |
| 250 |
| EA |
| $ |
| $ |
| 0097 |
| Altered Cast Model Service |
| 10 |
| EA |
| $ |
| $ |
| 0098 |
| Articulation (for simple hinge articulators) |
| 10 |
| EA |
| $ |
| $ |
| 0099 |
| Articulation (for semi-adjustable articulators) |
| 250 |
| EA |
| $ |
| $ |
| 0100 |
| Wironium Partial Denture Framework (includes 2 clasps) |
| 135 |
| EA |
| $ |
| $ |
| 0101 |
| Wironium Unilateral Partial Denture Framework (includes 2 clasps) |
| 1 |
| EA |
| $ |
| $ |
| 0102 |
| Wironium Swing-Lock Partial Denture Framework (includes hinge/attachment components) |
| 1 |
| EA |
| $ |
| $ |
| 0103 |
| Wironium Complete Denture Cast Base |
| 1 |
| EA |
| $ |
| $ |
QUANTITIES
COST
TOTAL
COST
| 0104 |
| Wironium Obturator Framework |
| 1 |
| EA |
| $ |
| $ |
| 0105 |
| Additional Cast Clasp for Partial Denture Framework |
| 50 |
| EA |
| $ |
| $ |
| 0106 |
| Metal Pontic for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0107 |
| Metal Onlay for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0108 |
| Metal Backing for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0109 |
| Metal masking/Opaque for Partial Denture Framework |
| 10 |
| EA |
| $ |
| $ |
| 0110 |
| Silicoating for Partial Denture Framework |
| 1 |
| EA |
| $ |
| $ |
| 0111 |
| DSE Hinge for Partial Denture Framework |
| 1 |
| EA |
| $ |
| $ |
| 0112 |
| Gold Framework for Partials *Alloy billed separately |
| 1 |
| EA |
| $ |
| $ |
| 0113 |
| Process and Finish, Flexible Partial Denture (1 -2 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0114 |
| Process and Finish, Flexible Partial Denture (3 -6 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0115 |
| Process and Finish, Flexible Partial Denture (7 or more teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0116 |
| Set-up, Process and Finish, Flexible Partial Denture (1 -2 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0117 |
| Set-up, Process and Finish, Flexible Partial Denture (3 -6 teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0118 |
| Set-up, Process and Finish, Flexible Partial Denture (7 or more teeth) *VA provides teeth |
| 1 |
| EA |
| $ |
| $ |
| 0119 |
| Denture Teeth, Dentsply Portrait IPN, Anterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0120 |
| Denture Teeth, Dentsply Portrait IPN, Anterior Teeth, Set of 6 |
| 5 |
| EA |
| $ |
| $ |
| 0121 |
| Denture Teeth, Dentsply Bioblend IPN, Anterior Tooth, EACH |
| 50 |
| EA |
| $ |
| $ |
| 0122 |
| Denture Teeth, Dentsply Bioblend IPN, Anterior Teeth, Set of 6 |
| 50 |
| EA |
| $ |
| $ |
| 0123 |
| Denture Teeth, Dentsply Portrait IPN, Posterior Tooth, EACH |
| 50 |
| EA |
| $ |
This is the start of the file's text. The full file is on GovTribe.
