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OP1
| Ordering Period 1 (November 1, 2021 to October 31, 2022) | | | | | |
| CLIN | Description | Estimated Quantity | Unit | Proposed Rate | Total Cost (Column D x F) |
| 0001 | Internal Cochlear Implant | 300 | Each | $0.00 |
| Models: | | | |
| 0002 | Initial Sound Processor Kit with Two Processors | 70 | Each | $0.00 |
| Please complete Attachment XX | | | |
| 0003 | Sound Processor Upgrade Kit | 960 | Each | $0.00 |
| Please complete Attachment XX | | | |
| 0004 | Sound Processor Standalone | 70 | Each | $0.00 |
| Models: | | | |
| Grand Total | | | | $0.00 |
OP2
| Ordering Period 2 (November 1, 2022 to October 31, 2023) | | | | | |
| CLIN | Description | Estimated Quantity | Unit | Proposed Rate | Total Cost (Column D x F) |
| 0001 | Internal Cochlear Implant | 330 | Each | $0.00 |
| Models: | | | |
| 0002 | Initial Sound Processor Kit with Two Processors | 77 | Each | $0.00 |
| Models: | | | |
| 0003 | Sound Processor Upgrade Kit | 1056 | Each | $0.00 |
| Models: | | | |
| 0004 | Sound Processor Standalone | 77 | Each | $0.00 |
| Models: | | | |
| Grand Total | | | | $0.00 |
OP3
| Ordering Period 3 (November 1, 2023 to October 31, 2024) | | | | | |
| CLIN | Description | Estimated Quantity | Unit | Proposed Rate | Total Cost (Column D x F) |
| 0001 | Internal Cochlear Implant | 363 | Each | $0.00 |
| Models: | | | |
| 0002 | Initial Sound Processor Kit with Two Processors | 85 | Each | $0.00 |
| Models: | | | |
| 0003 | Sound Processor Upgrade Kit | 1162 | Each | $0.00 |
| Models: | | | |
| 0004 | Sound Processor Standalone | 85 | Each | $0.00 |
| Models: | | | |
| Grand Total | | | | $0.00 |
OP4
| Ordering Period 4 (November 1, 2024 to October 31, 2025) | | | | | |
| CLIN | Description | Estimated Quantity | Unit | Proposed Rate | Total Cost (Column D x F) |
| 0001 | Internal Cochlear Implant | 399 | Each | $0.00 |
| Models: | | | |
| 0002 | Initial Sound Processor Kit with Two Processors | 93 | Each | $0.00 |
| Models: | | | |
| 0003 | Sound Processor Upgrade Kit | 1278 | Each | $0.00 |
| Models: | | | |
| 0004 | Sound Processor Standalone | 93 | Each | $0.00 |
| Models: | | | |
| Grand Total | | | | $0.00 |
OP5
| Ordering Period 5 (November 1, 2025 to October 31, 2026) | | | | | |
| CLIN | Description | Estimated Quantity | Unit | Proposed Rate | Total Cost (Column D x F) |
| 0001 | Internal Cochlear Implant | 439 | Each | $0.00 |
| Models: | | | |
| 0002 | Initial Sound Processor Kit with Two Processors | 102 | Each | $0.00 |
| Models: | | | |
| 0003 | Sound Processor Upgrade Kit | 1406 | Each | $0.00 |
| Models: | | | |
| 0004 | Sound Processor Standalone | 102 | Each | $0.00 |
| Models: | | | |
| Grand Total | | | | $0.00 |
Total Evaluated Price This sheet is pre populated.
| Ordering Period 1 | $0.00 |
| Ordering Period 2 | $0.00 |
| Ordering Period 3 | $0.00 |
| Ordering Period 4 | $0.00 |
| Ordering Period 5 | $0.00 |
| Total Evaluated Price | $0.00 |