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Attachment B. PRICE/COST SCHEDULE
MINIMUM AND MAXIMUM AMOUNTS
This is an Indefinite-Delivery, Indefinite Quantity (IDIQ) contract. Accordingly, all quantities are estimates only and are not ordered upon award of this contract. Funds are obligated via purchase orders issued against this contract. The Government shall order the below specified minimum contract value of services and may order up to the below specified maximum contract value of services through orders under this basic IDIQ contract for all ordering periods. The maximum amount under this contract is not guaranteed.
IDIQ contract Minimum: $2,000.00 IDIQ contract Maximum: $190,000.00
All funds are subject to the availability of funds per FAR 52.232-18.
Contractor shall fabricate and furnish the following dental products in accordance with the terms and conditions herein for the VA Medical Center, Erie, PA.
BASE PERIOD: 10/14/2020 –09/30/2021
REPAIRS
| ESTIMATED VOLUME |
| UNIT COST |
| TOTAL COST |
| Basic Acrylic Repair (i.e., crack or broken flange) |
| 7 |
| $ |
| $ |
| Charge for adding one (1) tooth in addition to basic repair (lab determines tooth brand) |
| 20 |
| Additional charge per tooth using IPN anterior |
| 12 |
| $ |
| $ |
| Additional charge per tooth using IPN posterior |
| 12 |
| $ |
| $ |
Adding clasp in addition to basic repair:
Wrought wire Cast clasp ___6___ ___1___
| Wire reinforcement in addition to acrylic repair |
| 2 |
| $ |
| $ |
| Mesh reinforcement in addition to acrylic repair |
| 2 |
| $ |
| $ |
| Weld to partial with repair |
| 1 |
| $ |
| $ |
Relines Traditional:
Complete Denture Partial Denture Lab processed soft reline material that should last up to five (5) years
___14___ ___5___ ___1___
Rebases:
Partial Denture ___1___ ___1___
| All acrylic partial (flipper) one (1) tooth (IPN) |
| 5 total |
| $ |
| $ |
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
| All acrylic partial additional charge for each cast clasp |
| 1 |
| $ |
| $ |
| All acrylic partial additional charge for each wrought iron clasp |
| 1 |
| $ |
| $ |
Repairable flexible acrylic partial such as Duraflex:
1 tooth (IPN)
_20 total___
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
Custom Trays: (4 stops and should end 1 mm above line scribed by dentist made from TRIAD material no shellac vacuform)
100 total
DO NOT PRICE
| Crown and bridge custom tray |
| 20 |
| $ |
| $ |
| Complete denture custom tray |
| 50 |
| $ |
| $ |
| Partial denture custom tray |
| 30 |
| $ |
| $ |
| Bite Block/Bite Rim for Dentures (TRIAD material not shellac Vacuform) |
| 50 |
| $ |
| $ |
Partial Dentures:
| Cost for metal framework (chrome cobalt with clasps) |
| 20 total |
| $ |
| $ |
| Basic Set-up charge |
| 20 |
| $ |
| $ |
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
| Process and finish charge |
| 20 |
| $ |
| $ |
Does finish charge include identification Yes ____
No ____
| If No, what is additional charge for Identification? |
| 20 |
| $ |
| $ |
| Complete Dentures |
| 50 total |
| DO NOT PRICE |
| Additional charge for IPN teeth (1x14) |
| 50 |
| $ |
| $ |
| Process and finish |
| 50 |
| $ |
| $ |
Does this include Identification Yes ____
No ____
| If no, what additional charge for Identification |
| 50 |
| $ |
| $ |
Crown and Bridge (includes pouring impressions and making dies)
54 units total
DO NOT PRICE
| Crown: porcelain with noble metal |
| 30 units |
| $ |
| $ |
| Crown: full cast high noble metal (dental gold) |
| 10 units |
| $ |
| $ |
Additional charge per pennyweight used
| Bridge Abutment: Crown porcelain with noble metal |
| 6 units |
| $ |
| $ |
Bridge Abutment Crown full cast high noble metal (dental gold)
3 units
Additional charge per pennyweight used
| Porcelain with ceramic substrate |
| 5 units |
| $ |
| $ |
What specific brands are available? (anterior tooth)
Examples: Zirconia, Bruxzir, Emax, etc.
What specific brands are available? (posterior tooth)
Mouthguards currently made at VA (to be discussed if needed) flexible or combination flexible with hard biting surface.
TOTAL ESTIMATED COST FOR BASE PERIOD $ ________________
Other Dental Lab Services: As necessary by agreement between the Erie VAMC’s Chief, Dental and the Contractor for any additional dental lab services which then will require a contract modification.
PRICE/COST SCHEDULE
OPTION YEAR 1: 10/01/2021 – 9/30/2022
REPAIRS
| ESTIMATED VOLUME |
| UNIT COST |
| TOTAL COST |
| Basic Acrylic Repair (i.e., crack or broken flange) |
| 7 |
| $ |
| $ |
| Charge for adding one (1) tooth in addition to basic repair (lab determines tooth brand) |
| 20 |
| Additional charge per tooth using IPN anterior |
| 12 |
| $ |
| $ |
| Additional charge per tooth using IPN posterior |
| 12 |
| $ |
| $ |
Adding clasp in addition to basic repair:
Cast clasp ___6___ ___1___
| Wire reinforcement in addition to acrylic repair |
| 2 |
| $ |
| $ |
| Mesh reinforcement in addition to acrylic repair |
| 2 |
| $ |
| $ |
| Weld to partial with repair |
| 1 |
| $ |
| $ |
Relines Traditional:
Partial Denture Lab processed soft reline material that should last up to five (5) years
___14___ ___5___ ___1___
Rebases:
Partial Denture ___1___ ___1___
| All acrylic partial (flipper) one (1) tooth (IPN) |
| 5 total |
| $ |
| $ |
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
| All acrylic partial additional charge for each cast clasp |
| 1 |
| $ |
| $ |
| All acrylic partial additional charge for each wrought iron clasp |
| 1 |
| $ |
| $ |
Repairable flexible acrylic partial such as Duraflex:
_20 total___
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
Custom Trays: (4 stops and should end 1 mm above line scribed by dentist made from TRIAD material no shellac vacuform)
| Crown and bridge custom tray |
| 20 |
| $ |
| $ |
| Complete denture custom tray |
| 50 |
| $ |
| $ |
| Partial denture custom tray |
| 30 |
| $ |
| $ |
| Bite Block/Bite Rim for Dentures (TRIAD material not shellac Vacuform) |
| 50 |
| $ |
| $ |
Partial Dentures:
| Cost for metal framework (chrome cobalt with clasps) |
| 20 total |
| $ |
| $ |
| Basic Set-up charge |
| 20 |
| $ |
| $ |
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
| Process and finish charge |
| 20 |
| $ |
| $ |
Does finish charge include identification Yes ____
No ____
| If No, what is additional charge for Identification? |
| 20 |
| $ |
| $ |
| Complete Dentures |
| 50 total |
| DO NOT PRICE |
| Additional charge for IPN teeth (1x14) |
| 50 |
| $ |
| $ |
| Process and finish |
| 50 |
| $ |
| $ |
Does this include Identification Yes ____
No ____
| If no, what additional charge for Identification |
| 50 |
| $ |
| $ |
Crown and Bridge (includes pouring impressions and making dies)
DO NOT PRICE
| Crown: porcelain with noble metal |
| 30 units |
| $ |
| $ |
| Crown: full cast high noble metal (dental gold) |
| 10 units |
| $ |
| $ |
Additional charge per pennyweight used
| Bridge Abutment: Crown porcelain with noble metal |
| 6 units |
| $ |
| $ |
Bridge Abutment Crown full cast high noble metal (dental gold)
3 units
Additional charge per pennyweight used
| Porcelain with ceramic substrate |
| 5 units |
| $ |
| $ |
What specific brands are available? (anterior tooth)
Examples: Zirconia, Bruxzir, Emax, etc.
What specific brands are available? (posterior tooth)
Mouthguards currently made at VA (to be discussed if needed) flexible or combination flexible with hard biting surface.
TOTAL ESTIMATED COST FOR OPTION YEAR 1 $________________
Other Dental Lab Services: As necessary by agreement between the Erie VAMC’s Chief, Dental and the Contractor for any additional dental lab services which then will require a contract modification.
PRICE/COST SCHEDULE
OPTION YEAR 2: 10/01/2022 – 09/30/2023
REPAIRS
| ESTIMATED VOLUME |
| UNIT COST |
| TOTAL COST |
| Basic Acrylic Repair (i.e., crack or broken flange) |
| 7 |
| $ |
| $ |
| Charge for adding one (1) tooth in addition to basic repair (lab determines tooth brand) |
| 20 |
| Additional charge per tooth using IPN anterior |
| 12 |
| $ |
| $ |
| Additional charge per tooth using IPN posterior |
| 12 |
| $ |
| $ |
Adding clasp in addition to basic repair:
Cast clasp ___6___ ___1___
| Wire reinforcement in addition to acrylic repair |
| 2 |
| $ |
| $ |
| Mesh reinforcement in addition to acrylic repair |
| 2 |
| $ |
| $ |
| Weld to partial with repair |
| 1 |
| $ |
| $ |
Relines Traditional:
Partial Denture Lab processed soft reline material that should last up to five (5) years
___14___ ___5___ ___1___
Rebases:
Partial Denture ___1___ ___1___
| All acrylic partial (flipper) one (1) tooth (IPN) |
| 5 total |
| $ |
| $ |
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
| All acrylic partial additional charge for each cast clasp |
| 1 |
| $ |
| $ |
| All acrylic partial additional charge for each wrought iron clasp |
| 1 |
| $ |
| $ |
Repairable flexible acrylic partial such as Duraflex:
_20 total___
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
Custom Trays: (4 stops and should end 1 mm above line scribed by dentist made from TRIAD material no shellac vacuform)
| Crown and bridge custom tray |
| 20 |
| $ |
| $ |
| Complete denture custom tray |
| 50 |
| $ |
| $ |
| Partial denture custom tray |
| 30 |
| $ |
| $ |
| Bite Block/Bite Rim for Dentures (TRIAD material not shellac Vacuform) |
| 50 |
| $ |
| $ |
Partial Dentures:
| Cost for metal framework (chrome cobalt with clasps) |
| 20 total |
| $ |
| $ |
| Basic Set-up charge |
| 20 |
| $ |
| $ |
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
| Process and finish charge |
| 20 |
Does finish charge include identification Yes ____
No ____
| If No, what is additional charge for Identification? |
| 20 |
| $ |
| $ |
| Complete Dentures |
| 50 total |
| DO NOT PRICE |
| Additional charge for IPN teeth (1x14) |
| 50 |
| $ |
| $ |
| Process and finish |
| 50 |
| $ |
| $ |
Does this include Identification Yes ____
No ____
| If no, what additional charge for Identification |
| 50 |
| $ |
| $ |
Crown and Bridge (includes pouring impressions and making dies)
DO NOT PRICE
| Crown: porcelain with noble metal |
| 30 units |
| $ |
| $ |
| Crown: full cast high noble metal (dental gold) |
| 10 units |
| $ |
| $ |
Additional charge per pennyweight used
| Bridge Abutment: Crown porcelain with noble metal |
| 6 units |
| $ |
| $ |
Bridge Abutment Crown full cast high noble metal (dental gold)
3 units
Additional charge per pennyweight used
| Porcelain with ceramic substrate |
| 5 units |
| $ |
| $ |
What specific brands are available? (anterior tooth)
Examples: Zirconia, Bruxzir, Emax, etc.
What specific brands are available? (posterior tooth)
Mouthguards currently made at VA (to be discussed if needed) flexible or combination flexible with hard biting surface.
TOTAL ESTIMATED COST FOR OPTION YEAR 2 $_______________
Other Dental Lab Services: As necessary by agreement between the Erie VAMC’s Chief, Dental and the Contractor for any additional dental lab services which then will require a contract modification.
OPTION YEAR 3: 10/01/2023 –09/30/2024
REPAIRS
| ESTIMATED VOLUME |
| UNIT COST |
| TOTAL COST |
| Basic Acrylic Repair (i.e., crack or broken flange) |
| 7 |
| $ |
| $ |
| Charge for adding one (1) tooth in addition to basic repair (lab determines tooth brand) |
| 20 |
| Additional charge per tooth using IPN anterior |
| 12 |
| $ |
| $ |
| Additional charge per tooth using IPN posterior |
| 12 |
| $ |
| $ |
Adding clasp in addition to basic repair:
Cast clasp ___6___ ___1___
| Wire reinforcement in addition to acrylic repair |
| 2 |
| $ |
| $ |
| Mesh reinforcement in addition to acrylic repair |
| 2 |
| $ |
| $ |
| Weld to partial with repair |
| 1 |
| $ |
| $ |
Relines Traditional:
Partial Denture Lab processed soft reline material that should last up to five (5) years
___14___ ___5___ ___1___
Rebases:
Partial Denture ___1___ ___1___
| All acrylic partial (flipper) one (1) tooth (IPN) |
| 5 total |
| $ |
| $ |
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
| All acrylic partial additional charge for each cast clasp |
| 1 |
| $ |
| $ |
| All acrylic partial additional charge for each wrought iron clasp |
| 1 |
| $ |
| $ |
Repairable flexible acrylic partial such as Duraflex:
_20 total___
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
Custom Trays: (4 stops and should end 1 mm above line scribed by dentist made from TRIAD material no shellac vacuform)
Crown and bridge custom tray
| Complete denture custom tray |
| 50 |
| $ |
| $ |
| Partial denture custom tray |
| 30 |
| $ |
| $ |
| Bite Block/Bite Rim for Dentures (TRIAD material not shellac Vacuform) |
| 50 |
| $ |
| $ |
Partial Dentures:
| Cost for metal framework (chrome cobalt with clasps) |
| 20 total |
| $ |
| $ |
| Basic Set-up charge |
| 20 |
| $ |
| $ |
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
| Process and finish charge |
| 20 |
Does finish charge include identification Yes ____
No ____
| If No, what is additional charge for Identification? |
| 20 |
| $ |
| $ |
| Complete Dentures |
| 50 total |
| DO NOT PRICE |
| Additional charge for IPN teeth (1x14) |
| 50 |
| $ |
| $ |
| Process and finish |
| 50 |
| $ |
| $ |
Does this include Identification Yes ____
No ____
| If no, what additional charge for Identification |
| 50 |
| $ |
| $ |
Crown and Bridge (includes pouring impressions and making dies)
DO NOT PRICE
| Crown: porcelain with noble metal |
| 30 units |
| $ |
| $ |
| Crown: full cast high noble metal (dental gold) |
| 10 units |
| $ |
| $ |
Additional charge per pennyweight used
| Bridge Abutment: Crown porcelain with noble metal |
| 6 units |
| $ |
| $ |
Bridge Abutment Crown full cast high noble metal (dental gold)
3 units
Additional charge per pennyweight used
| Porcelain with ceramic substrate |
| 5 units |
| $ |
| $ |
What specific brands are available? (anterior tooth)
Examples: Zirconia, Bruxzir, Emax, etc.
What specific brands are available? (posterior tooth)
Mouthguards currently made at VA (to be discussed if needed) flexible or combination flexible with hard biting surface.
TOTAL ESTIMATED COST FOR OPTION YEAR 3 $_______________
Other Dental Lab Services: As necessary by agreement between the Erie VAMC’s Chief, Dental and the Contractor for any additional dental lab services which then will require a contract modification.
OPTION YEAR 4: 10/01/2024 – 09/30/2025
REPAIRS
| ESTIMATED VOLUME |
| UNIT COST |
| TOTAL COST |
| Basic Acrylic Repair (i.e., crack or broken flange) |
| 7 |
| $ |
| $ |
| Charge for adding one (1) tooth in addition to basic repair (lab determines tooth brand) |
| 20 |
| Additional charge per tooth using IPN anterior |
| 12 |
| $ |
| $ |
| Additional charge per tooth using IPN posterior |
| 12 |
| $ |
| $ |
Adding clasp in addition to basic repair:
Cast clasp ___6___ ___1___
| Wire reinforcement in addition to acrylic repair |
| 2 |
| $ |
| $ |
| Mesh reinforcement in addition to acrylic repair |
| 2 |
| $ |
| $ |
| Weld to partial with repair |
| 1 |
| $ |
| $ |
Relines Traditional:
Partial Denture Lab processed soft reline material that should last up to five (5) years
___14___ ___5___ ___1___
Rebases:
Partial Denture ___1___ ___1___
| All acrylic partial (flipper) one (1) tooth (IPN) |
| 5 total |
| $ |
| $ |
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
| All acrylic partial additional charge for each cast clasp |
| 1 |
| $ |
| $ |
| All acrylic partial additional charge for each wrought iron clasp |
| 1 |
| $ |
| $ |
Repairable flexible acrylic partial such as Duraflex:
_20 total___
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
Custom Trays: (4 stops and should end 1 mm above line scribed by dentist made from TRIAD material no shellac vacuform)
| Crown and bridge custom tray |
| 20 |
| $ |
| $ |
| Complete denture custom tray |
| 50 |
| $ |
| $ |
| Partial denture custom tray |
| 30 |
| $ |
| $ |
| Bite Block/Bite Rim for Dentures (TRIAD material not shellac Vacuform) |
| 50 |
| $ |
| $ |
Partial Dentures:
| Cost for metal framework (chrome cobalt with clasps) |
| 20 total |
| $ |
| $ |
| Basic Set-up charge |
| 20 |
| $ |
| $ |
| Additional charge for each IPN anterior tooth |
| 1 |
| $ |
| $ |
| Additional charge for each IPN posterior tooth |
| 1 |
| $ |
| $ |
| Process and finish charge |
| __20__ |
| $ |
| $ |
Does finish charge include identification Yes ____
No ____
| If No, what is additional charge for Identification? |
| 20 |
| $ |
| $ |
| Complete Dentures |
| 50 total |
| DO NOT PRICE |
| Additional charge for IPN teeth (1x14) |
| 50 |
| $ |
| $ |
| Process and finish |
| 50 |
| $ |
| $ |
Does this include Identification Yes ____
No ____
| If no, what additional charge for Identification |
| 50 |
| $ |
| $ |
Crown and Bridge (includes pouring impressions and making dies)
DO NOT PRICE
| Crown: porcelain with noble metal |
| 30 units |
| $ |
| $ |
| Crown: full cast high noble metal (dental gold) |
| 10 units |
| $ |
| $ |
Additional charge per pennyweight used
| Bridge Abutment: Crown porcelain with noble metal |
| 6 units |
| $ |
| $ |
Bridge Abutment Crown full cast high noble metal (dental gold)
3 units
Additional charge per pennyweight used
| Porcelain with ceramic substrate |
| 5 units |
| $ |
| $ |
What specific brands are available? (anterior tooth)
Examples: Zirconia, Bruxzir, Emax, etc.
What specific brands are available? (posterior tooth)
| Mouthguards currently made at VA (to be discussed if needed) flexible or combination flexible with hard biting surface. |
| 10 |
| $ |
| $ |
TOTAL ESTIMATED COST FOR OPTION YEAR 4 $________________
ESTIMATED GRAND TOTAL FOR FIVE PERIODS $__________________
Other Dental Lab Services: As necessary by agreement between the Erie VAMC’s Chief, Dental and the Contractor for any additional dental lab services which then will require a contract modification.
