Pricing Spreadsheet.xlsx
XLSX spreadsheet 70 KB Posted
- Attached to
- 6515--Cochlear Implant Acquisition (VA-19-00099570) Federal contract opportunity
- Solicitation number
- 36C79121R0005
About this file
This document contains a pricing spreadsheet template for the procurement of hearing aids and related accessories from vendors for the Department of Veterans Affairs.
The template includes pricing tables for eight categories of hearing aid devices including custom digital and behind-the-ear models, as well as accessories such as filters, tubing, batteries, and replacement parts. Pricing must be provided for a base year and four option years. Categories include non-rechargeable and rechargeable options for hearing aids, wireless systems, ear molds, remote controls, CROS transmitters, devices compatible with cochlear implants, and optional services like ear scans. Estimated volumes are provided for accessories. Vendors must complete the template to be considered for Solicitation Number 36C79121R0005 for cochlear implant acquisitions for VA Network 19 with an opportunity type of Solicitation.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C79121R0005_5.docx | DOCX document | |
| Attachment D-8 Proposal Pricing Sheet (CLINs X001 to X004).xlsx | XLSX spreadsheet | |
| 36C79121R0005 A0001.docx | DOCX document | |
| 36C79121R0005_4.docx | DOCX document | |
| Attachment D-9 Proposal Pricing Sheet (CLINs X005 and X006).xlsx | XLSX spreadsheet | |
| 36C79121R0005_2.docx | DOCX document | |
| List of Attachments.docx | DOCX document | |
| 36C79121R0005.docx | DOCX document | |
| S02 36C79121R0005.docx | DOCX document | |
| 36C79121R0005_3.docx | DOCX document | |
| 36C79121R0005_1.docx | DOCX document |
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Text version
GROUP 1 CHA NON-RECHARGEABLE
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS Code: | |||||
| GROUP 1 CATEGORY 1 | CUSTOM (CHA) DIGITAL HEARING AIDS NON-RECHARGEABLE POWER (REQUIRED) | ||||
| GROUP 1 CATEGORY 1 Minimum of 1, Maximum of 4 | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 1 | FULL SHELL | $0.00 |
CLIN 1 FULL SHELL $0.00
CLIN 1 FULL SHELL $0.00
CLIN 1 FULL SHELL $0.00
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS/Code: | |||||
| GROUP 1 CATEGORY 1 | CUSTOM (CHA) DIGITAL HEARING AIDS NON-RECHARGEABLE POWER (REQUIRED) | ||||
| GROUP 1 CATEGORY 1 Minimum of 1, Maximum of 4 | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 2 | HALF SHELL | $0.00 |
CLIN 2 HALF SHELL $0.00
CLIN 2 HALF SHELL $0.00
CLIN 2 HALF SHELL $0.00
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS/Code: | |||||
| GROUP 1 CATEGORY 1 | CUSTOM (CHA) DIGITAL HEARING AIDS NON-RECHARGEABLE POWER (REQUIRED) | ||||
| GROUP 1 CATEGORY 1 Minimum of 1, Maximum of 4 | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 3 | CANAL | $0.00 |
CLIN 3 CANAL $0.00
CLIN 3 CANAL $0.00
CLIN 3 CANAL $0.00
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS/Code: | |||||
| GROUP 1 CATEGORY 1 | CUSTOM (CHA) DIGITAL HEARING AIDS NON-RECHARGEABLE POWER (REQUIRED) | ||||
| GROUP 1 CATEGORY 1 Minimum of 1, Maximum of 4 | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 4 | CIC | $0.00 |
CLIN 4 CIC $0.00
CLIN 4 CIC $0.00
CLIN 4 CIC $0.00
GROUP 1 CHA RECHARGEABLE (O)
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS/Code: | |||||
| GROUP 1 CATEGORY 2 | CUSTOM (CHA) DIGITAL HEARING AIDS RECHARGEABLE POWER (OPTIONAL) | ||||
| GROUP 1 CATEGORY 2 Maximum of 8 | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 5 | $0.00 |
CLIN 5 $0.00
CLIN 5 $0.00
CLIN 5 $0.00
GROUP 2 BTE NON-RECHARGEABLE
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS Code: | |||||
| GROUP 2 CATEGORY 1 | BEHIND-THE-EAR (BTE) DIGITAL HEARING AIDS NON-RECHARGEABLE POWER (REQUIRED) | ||||
| GROUP 2 CATEGORY 1 Minimum of 2, Maximum of 8 | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 6 | BTE | $0.00 |
CLIN 6 BTE $0.00
CLIN 6 BTE $0.00
CLIN 6 BTE $0.00
CLIN 6 BTE $0.00
CLIN 6 BTE $0.00
CLIN 6 BTE $0.00
CLIN 6 BTE $0.00
GROUP 2 BTE RECHARGEABLE (O)
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS Code: | |||||
| GROUP 2 CATEGORY 2 | BEHIND-THE-EAR (BTE) DIGITAL HEARING AIDS RECHARGEABLE POWER (OPTIONAL) | ||||
| GROUP 2 CATEGORY 2 Maximum of 8 | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 7 | $0.00 |
CLIN 7 $0.00
CLIN 7 $0.00
CLIN 7 $0.00
CLIN 7 $0.00
CLIN 7 $0.00
CLIN 7 $0.00
CLIN 7 $0.00
GROUP 3 RIC NON-RECHARGEABLE
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS Code: | |||||
| GROUP 3 CATEGORY 1 | RECEIVER-IN-THE-CANAL (RIC) DIGITAL HEARING AIDS NON-RECHARGEABLE (REQUIRED) | ||||
| GROUP 3 CATEGORY 1 Minimum of 1, Maximum of 8 | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 8 | RIC | $0.00 |
CLIN 8 RIC $0.00
CLIN 8 RIC $0.00
CLIN 8 RIC $0.00
CLIN 8 RIC $0.00
CLIN 8 RIC $0.00
CLIN 8 RIC $0.00
CLIN 8 RIC $0.00
GROUP 3 RECHARGEABLE (O)
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS Code: | |||||
| GROUP 3 CATEGORY 2 | RECEIVER-IN-THE-CANAL (RIC) DIGITAL HEARING AIDS RECHARGEABLE (OPTIONAL) | ||||
| GROUP 3 CATEGORY 1 Minimum of 1, Maximum of 8 | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 9 | $0.00 |
CLIN 9 $0.00
CLIN 9 $0.00
CLIN 9 $0.00
CLIN 9 $0.00
CLIN 9 $0.00
CLIN 9 $0.00
CLIN 9 $0.00
GROUP 4 WIRELESS
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS Code: | |||||
| GROUP 4 CATEGORY 1 | WIRELESS SYSTEMS (REQUIRED) | ||||
| Group 4 Category 1 No Maximum | |||||
| CLIN 10 | MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price |
| CLIN 10a | $0.00 |
CLIN 10b $0.00
CLIN 10c $0.00
CLIN 10d $0.00
CLIN 10e $0.00
CLIN 10f $0.00
*add additional lines as necessary
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS/Code: | |||||
| GROUP 4 CATEGORY 2 | WIRELESS FM SYSTEMS (OPTIONAL) | ||||
| GROUP 4 CATEGORY 2 No Maximum | |||||
| CLIN 11 | MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price |
| CLIN 11a | $0.00 |
CLIN 11b $0.00
CLIN 11c $0.00
CLIN 11d $0.00
CLIN 11e $0.00
| CLIN 11f | $0.00 |
| *add additional lines as necessary |
ACCESSORIES CHIN STRAPS
Please Note: As part of the proposal, the offeror shall provide pricing for the base year and all option periods.
OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________
| HCPCS/L Code: A7036 | Suggested HCPCS/L Code (if different): ________________ Pre-Approved Items for this CLIN are listed in Attachment F | |||||||||
| ACCESSORIES - CHIN STRAPS-(See Attachment D for Minimum Technical Requirements and Attacment F for Pre-Approved Items List) | ||||||||||
| **Estimated quantity: 29,143. Estimated quantities for Chin Straps comprise of various models, sizes and features. These estimated quantities are estimates only and are not commitments. | ||||||||||
| CORRESPONDING SUB CLIN FOR PAP DEVICE | MODEL/BRAND | ITEM DESCRIPTION CHIN STRAPS | DETAILED DESCRIPTION OF ITEM OFFERED | PLACE OF MANUFACTURE | SIZE | UNIT PRICE BASE YEAR | UNIT PRICE OPTION PERIOD I | UNIT PRICE OPTION PERIOD II | UNIT PRICE OPTION PERIOD III | UNIT PRICE OPTION PERIOD IV |
| $0.00 | $0.00 | |||||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| TOTAL PRICE FOR BASE AND ALL OPTION PERIODS |
ACCESSORIES FILTERS
Please Note: As part of the proposal, the offeror shall provide pricing for the base year and all option periods.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | ||||||||||
| *Corresponding PAP device CLIN must be specified in column A for each accessory offered. | ||||||||||
| HCPCS/L Code: A7038 | Suggested HCPCS/L Code (if different): ________________ Pre-Approved Items for this CLIN are listed in Attachment F | |||||||||
| ACCESSORIES - FILTERS (Disposable and Non Disposable)/(See Attachment D for Minimum Technical Requirements and Attacment F for Pre-Approved Items | ||||||||||
| **Estimated quantity: 344288. Estimated quantities for Filters comprise of various models, sizes and features. These estimated quantities are estimates only and are not commitments. | ||||||||||
| *CORRESPONDING CLIN FOR PAP DEVICE | MODEL/BRAND | ITEM DESCRIPTION | DETAILED DESCRIPTION OF ITEM OFFERED | PLACE OF MANUFACTURE | SIZE | UNIT PRICE BASE YEAR | UNIT PRICE OPTION PERIOD I | UNIT PRICE OPTION PERIOD II | UNIT PRICE OPTION PERIOD III | UNIT PRICE OPTION PERIOD IV |
| Filters (Non Disposalble) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| Filters (Non Disposalble) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| TOTAL PRICE FOR BASE AND ALL OPTION PERIODS |
GROUP 5 EARMOLDS
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS Code: | |||||
| GROUP 5 | EARMOLDS FOR HEARING AIDS *pricing is for earmolds purchased after trail period | ||||
| GROUP 5 No Maximum | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 12 | $0.00 |
CLIN 12 $0.00
CLIN 12 $0.00
CLIN 12 $0.00
*add additional lines as necessary
GROUP 6 REMOTES (O)
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS Code: | |||||
| GROUP 6 | SIMPLE WIRELESS REMOTE CONTROLS (OPTIONAL) | ||||
| Group 6 No Maximum | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 13 | $0.00 |
CLIN 13 $0.00
CLIN 13 $0.00
CLIN 13 $0.00
GROUP 7 CROS NON-RECHARGE (O)
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS Code: | |||||
| GROUP 7 CATEGORY 1 | WIRELESS CROS TRANSMITTERS NON-RECHARGEABLE POWER (OPTIONAL) | ||||
| Group 7 No Maximum | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 14 | $0.00 |
CLIN 14 $0.00
CLIN 14 $0.00
CLIN 14 $0.00
GROUP 7 CROS RECHARGEABLE (O)
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS/Code: | |||||
| GROUP 7 CATEGORY 2 | WIRELESS CROS TRANSMITTERS RECHARGEABLE POWER (OPTIONAL) | ||||
| Group 7 No Maximum | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 15 | $0.00 |
CLIN 15 $0.00
CLIN 15 $0.00
CLIN 15 $0.00
GROUP 8 CI COMPTATIBLE (O)
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS Code: | |||||
| GROUP 8 CATEGORY 1 | CI COMPATIBLE DEVICES - HEARING AIDS (OPTIONAL) | ||||
| No Maximum | |||||
| CLIN 16 | MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price |
| CLIN 16a | $0.00 |
CLIN 16b $0.00
CLIN 16c $0.00
CLIN 16d $0.00
CLIN 16e $0.00
CLIN 106f $0.00
*add additional lines as necessary
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS/Code: | |||||
| GROUP 8 CATEGORY 2 | CI COMPATIBLE DEVICES - WIRELESS SYSTESM (OPTIONAL) | ||||
| Group 8 No Maximum | |||||
| CLIN 17 | MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price |
| CLIN 17a | $0.00 |
CLIN 17b $0.00
CLIN 17c $0.00
CLIN 17d $0.00
CLIN 17e $0.00
| CLIN 17f | $0.00 |
| *add additional lines as necessary |
EAR SCAN (O)
Instructions/Examples: Each sheet within this workbook shall be used per Group.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||
| HCPCS Code: | |||||
| SEPERATELY PRICE ITEMS | EAR SCAN (OPTIONAL) | ||||
| No Maximum | |||||
| MODEL NAME | ITEM DESCRIPTION | PLACE OF MANUFACTURE | TOTAL UNIT PRICE FOR MODEL - ALL YEARS | Commercial price | |
| CLIN 18 | $0.00 |
CLIN 18 $0.00
CLIN 18 $0.00
CLIN 18 $0.00
TUBING
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ | |||||||||
| *Corresponding PAP device CLIN must be specified in column A for each accessory offered. | |||||||||
| Suggested HCPCS/L Code (if different): ________________ Pre-Approved Items for this CLIN are listed in Attachment F | |||||||||
| ACCESSORIES - TUBING (Standard, Heated/Climate)/(See Attachment D for Minimum Technical Requirements and Attacment F for Pre-Approved Items | |||||||||
| **Estimated quantity: 173,291. Estimated quantities for Tubing comprise of various models, sizes and features. These estimated quantities are estimates only and are not commitments. | |||||||||
| *CORRESPONDING CLIN FOR PAP DEVICE | ITEM DESCRIPTION | DETAILED DESCRIPTION OF ITEM OFFERED | PLACE OF MANUFACTURE | Lenth | UNIT PRICE BASE YEAR | UNIT PRICE OPTION PERIOD I | UNIT PRICE OPTION PERIOD II | UNIT PRICE OPTION PERIOD III | UNIT PRICE OPTION PERIOD IV |
| Tubing (Standard) 6 Feet | 6 Feet | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| Tubing (Standard) 10 Feet | 10 Feet | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| Tubing (Heated/Climate) 6 Feet | 6 Feet | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| Tubing (Heated/Climate) 10Feet | 10 Feet | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
REPLACEMENT PRTS_HUM_WATER_CHAM
Please Note: As part of the proposal, the offeror shall provide pricing for the base year and all option periods.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ |
| *Corresponding PAP device CLIN must be specified in column A for each accessory offered. |
| Suggested HCPCS/L Code (if different): ________________ |
| Replacement Part - (Humidifier Water Chamber)/(See Attachment D for Minimum Technical Requirements for PAP devices) |
| *CORRESPONDING CLIN FOR PAP DEVICE | REPLACEMENT PART DESCRIPTION | DETAILED DESCRIPTION OF ITEM OFFERED | PLACE OF MANUFACTURE | DESCRIPTION AND PAP MODEL FOR THIS REPLACEMENT PART BEING OFFERED | UNIT PRICE BASE YEAR | UNIT PRICE OPTION PERIOD I | UNIT PRICE OPTION PERIOD II | UNIT PRICE OPTION PERIOD III | UNIT PRICE OPTION PERIOD IV |
| Humidifier Water Chamber | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
REPLACEMENT PRTS_SD CARD
Please Note: As part of the proposal, the offeror shall provide pricing for the base year and all option periods.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ |
| *Corresponding PAP device CLIN must be specified in column A for each accessory offered. |
| Suggested HCPCS/L Code (if different): ________________ |
| Replacement Part - (SECURE DIGITAL CARDS)/(See Attachment D for Minimum Technical Requirements for PAP devices) |
| *CORRESPONDING CLIN FOR PAP DEVICE | REPLACEMENT PART DESCRIPTION | DETAILED DESCRIPTION OF ITEM OFFERED | PLACE OF MANUFACTURE | DESCRIPTION AND PAP MODEL FOR THIS REPLACEMENT PART BEING OFFERED | UNIT PRICE BASE YEAR | UNIT PRICE OPTION PERIOD I | UNIT PRICE OPTION PERIOD II | UNIT PRICE OPTION PERIOD III | UNIT PRICE OPTION PERIOD IV |
| SECURE DIGITAL CARDS (SD) CARDS | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
REPLACEMENT PRTS-POW SUP_CHOR
Please Note: As part of the proposal, the offeror shall provide pricing for the base year and all option periods.
| OFFEROR NAME (MANDATORY) : ___________________________________________________________________________________________ |
| *Corresponding PAP device CLIN must be specified in column A for each accessory offered. |
| Suggested HCPCS/L Code (if different): ________________ |
| Replacement Part - (POWER SUPPLY AND OR POWER CHORD)/(See Attachment D for Minimum Technical Requirements for PAP devices) |
| *CORRESPONDING CLIN FOR PAP DEVICE | REPLACEMENT PART DESCRIPTION | DETAILED DESCRIPTION OF ITEM OFFERED | PLACE OF MANUFACTURE | DESCRIPTION AND PAP MODEL FOR THIS REPLACEMENT PART BEING OFFERED | UNIT PRICE BASE YEAR | UNIT PRICE OPTION PERIOD I | UNIT PRICE OPTION PERIOD II | UNIT PRICE OPTION PERIOD III | UNIT PRICE OPTION PERIOD IV |
| POWER SUPPLY | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| POWER CHORD | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
File details come from the government source that posted it. Updated .