D.1 Individual Price Schedule 36C26025Q0204.xlsx
XLSX spreadsheet 34 KB Posted
- Solicitation number
- 36C26025Q0204
About this file
This is a detailed price schedule spreadsheet for dental laboratory services at VA Puget Sound Healthcare System, containing 216 line items across five CLINs (base year plus four option years). The schedule covers a comprehensive range of dental prosthetics including crowns, bridges, implants, dentures, nightguards, and related dental laboratory services, with specific estimated quantities for each item. Key categories include full gold crowns (20 units), digital lithium disilicate crowns (50 units), implant-related services, removable partial dentures (11 units), and various surgical guides and appliances.
The schedule supports a small business set-aside solicitation (NAICS 339116, Dental Laboratories) for dental laboratory services at VA Puget Sound's Seattle, Tacoma, and Mt Vernon clinics. The contract period includes a base year plus four option years, with anticipated start date of February 23, 2025. The contractor must provide comprehensive dental laboratory support including fabrication of removable, fixed, maxillofacial, surgical, and implant prosthetics, along with all necessary transportation, shipping, materials, and quality assurance. The price schedule requires vendors to input unit prices for each line item across all five years of potential performance.
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| File | Type | Posted |
|---|---|---|
| Updated D.1 Individual Price Schedule 36C26025Q0204 .xlsx | XLSX spreadsheet | |
| 36C26025Q0204 0001.docx | DOCX document | |
| 36C26025Q0204.docx | DOCX document |
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Puget Sound
| D.1 INDIVIDUAL PRICE SCHEDULE & ESTIMATED QUANTITIES | |||||||||||||
| Puget Sound | |||||||||||||
| Item No. | Description | Estimated Quantities | Unit | CLIN 0001 Unit Price | CLIN 0001 Est. Total Price | CLIN 1001 Unit Price | CLIN 1001 Est. Total Price | CLIN 2001 Unit Price | CLIN 2001 Est. Total Price | CLIN 3001 Unit Price | CLIN 3001 Est. Total Price | CLIN 4001 Unit Price | CLIN 4001 Est. Total Price |
| 1 | Full-Cast Crown Inlay/Onlay Yellow Gold | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 2 | Full Gold Crown | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 3 | Digital Full Gold Crown | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 4 | Full Gold Pontic | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 5 | Digital Full Gold Pontic | 25 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 6 | Post and Core | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 7 | Fit to Partial - Full Gold | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 8 | PVS Impression Lithium Disilicate Crown & Bridge | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 9 | PVS Impression Lithium Disilicate Veneer | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 10 | PVS Impression Lithium Disilicate Onlay/Inlay | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 11 | Digital Lithium Disilicate Crown & Bridge | 50 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 12 | Digital Lithium Disilicate Veneer | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 13 | Digital Lithium Disilicate Onlay/Inlay | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 14 | Digital Lithium Disilicate Layered | 25 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 15 | Model Free Lithium Disilicate Crown & Bridge | 50 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 16 | Model Free Lithium Disilicate Veneer | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 17 | PVS Impression Full Zirconia C&B | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 18 | PVS Impression Zirconia Pontic | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 19 | PVS Impression Zirconia Layered C&B | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 20 | Digital Full Zirconia C&B | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 21 | Digital Zirconia Monolithic Crown | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 22 | Model Free Zirconia C&B | 25 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 23 | Model Free Zirconia Pontic | 25 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 24 | Model Free Zirconia Veneer | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 25 | Model Free Zirconia Layered C&B | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 26 | Model Free Zirconia Maryland Bridge | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 26 | Check Model | 50 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 28 | Digital Printed Model Full Arch | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 30 | Digital Printed Model Quad Upper and Lower | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 31 | Porcelain to Metal | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 32 | Porcelain Fused to Metal Pontics | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 33 | Porcelain Labial Margins | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 35 | Maryland Bridge (1 Pontic; 2 Wings) | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 36 | Fit to Partial - Porcelain Fused to Metal | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 37 | Metal Occlusal | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 38 | Radio opaque surgical guide | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 39 | Implant diagnostic wax-up | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 40 | Stint/scan appliance with negative space centerlines (includes diagnostic wax-up) | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 41 | Centerline stint drill guide | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 42 | Soft tissue model | 40 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 43 | Vendor supplied analogs | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 44 | PVS Impression Abutment design and manufacture (Lab Supplied TI Abutment) | 40 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 45 | Digital Abutment Design and Manufacture (Lab Supplied Ti Abutment) | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 46 | Model Free Abutment Design and Manufacture (Lab Supplied Ti Abutment) | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 47 | Digital Hybrid Zirconia Abutment Design and Manufacture (Lab Supplied Zi Abutment) | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 48 | Digital Hybrid Zirconia Crown - Name Brand | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 49 | Digital Hybrid Zirconia Crown - FDA Approved CAD/CAM Hybrid | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 50 | Digital Hybrid Layered Zirconia Crown - Name Brand | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 51 | Digital Hybrid Layered Zirconia Crown - FDA Approved CAD/CAM Hybrid | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 52 | Model Free Hybrid Zirconia Crown - Name Brand Hybrid | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 53 | Model Free Hybrid Zirconia Crown - FDA Approved CAD/CAM Hybrid | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 54 | Lava Custom abutment including parts | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 55 | Lab analogs | 40 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 56 | Nobel, 3i, astra custom abutment | 40 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 57 | FDA approved CAD/CAM Abutment | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 58 | Replacement abutment screw | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 59 | Verification/Temp Cylinder | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 60 | Opaquing custom abutment | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 61 | Abutment seating index | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 62 | Implant stabilization impression index | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 63 | Centerline stint drill guide | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 64 | CAD PMMA Temp | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 65 | Egg Shell Temp | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 66 | Reduction Coping | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 67 | Precision Attachment | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 68 | Rest on Crown | 8 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 69 | Guide Plane Separate from Rest | 8 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 70 | Touch pads (Zi or metal) | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 71 | Rainbow bridge connector | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 72 | Under partial matrix (RPD replication) | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 73 | Digital Diagnostic Wax-Up | 15 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 74 | Full Denture complete(Max. or man, not Including Teeth) | 15 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 75 | 3D Printed Denture - incl Teeth | 15 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 76 | Denture Set Up (Try In) | 15 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 77 | 3D Printed Set Up (Try In) | 15 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 78 | Denture Processing/finishing | 15 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 79 | Base plate/bite rim | 15 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 80 | Reline complete denture | 7 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 81 | Model (bead, box, pour, trim) | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 82 | Rebase Complete Denture | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 83 | Duplicate Denture | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 84 | Removable Partial Dentures | 11 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 85 | Digital Removable Dentures - Teeth Included | 15 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 86 | Vitallium/Vitallium 2000 Partial Frame Only | 11 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 87 | Digital Vitallium/Vitallium 2000 - One Shot Partial includes teeth | 11 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 88 | Labial Hinge and Latch | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 89 | Denture ID | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 90 | Stress Breaker | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 91 | Cast Wire Clasp | 7 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 92 | Partial Wax-Up Try In | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 93 | Process Partial (per saddle) | 11 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 94 | Reline Removable Partial Denture (per saddle) | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 95 | Add Tooth to Removable Partial Denture | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 96 | Add Wrought Wire Clasp to Partial | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 97 | Thermoflex clasp | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 98 | Weld RPD (add clasp, add tooth, etc) | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 99 | RPD bite block (per saddle) | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 100 | Soldering (gold or silver) | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 101 | Cast Unit (for cast clasps) | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 102 | Metal Occlusal | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 103 | Rebase RPD (per saddle) | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 104 | Flipper Cold Cure (Interim partial denture, stayplate; not including teeth) | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 105 | 3D Printed Flipper (Interim partial denture, stayplate: includes one tooth) | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 106 | Flipper Heat Cure (Interim partial denture, stayplate; not including teeth) | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 107 | Set implant denture (not including teeth) | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 108 | Set up attachment case (not including teeth) | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 109 | Process/finish implant denture | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 110 | Process/finish attachment case | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 111 | Add implant on model | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 112 | Drill sleeve | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 113 | Drill stint | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 114 | Reline with attachment | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 115 | Abutment screw | 60 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 116 | Abutment-UCLA-gold | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 117 | Abutment - Multi unit | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 118 | Scanbody | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 119 | Digital Analog | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 120 | Analog | 60 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 121 | Analog-3I | 55 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 122 | Analog-Strauman | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 123 | Implant Ti Base - Name Brand | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 124 | Implant Ti Base - FDA Approved CAD/CAM | 20 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 125 | Delivery screw | 60 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 126 | ERA male only | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 127 | ERA RV housing | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 128 | Gingihue abutment | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 129 | Gold coping multi-unit | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 130 | Gold cylinder | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 131 | Hader clip | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 132 | Hader Housing | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 133 | Lab screw | 60 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 134 | Locator abutment head | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 135 | Locator housing | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 136 | Locator impression coping | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 137 | Locator males | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 138 | Plastic clip | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 139 | Attachment weld | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 140 | CAD CAM | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 141 | Cantilever Bar ext. | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 142 | Dual Frame Locator | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 143 | Fixed Detachable Bar | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 144 | Hard weld | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 145 | Hybrid framework | 7 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 146 | Implant bar | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 147 | All-on-X Zirconia (4 implant sites) | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 148 | All on X Composite Hybrid (4 implant sites) | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 149 | All on X Prototype (4 implant sites) | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 150 | All-on-X Zirconia - additional site | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 151 | All on X Composite Hybrid - aditional site | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 152 | All on X Prototype - additional site | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 153 | Implant single abutment | 50 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 154 | Mill implant bar | 5 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 155 | Mill lingual | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 156 | Threaded castable post | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 157 | Implant guide model | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 158 | Implant guide stent | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 159 | Implant temporary bridge | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 160 | Implant Temporary Crown | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 161 | MF Implant Temporary Crown | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 162 | Flexite Partial (not including teeth) | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 163 | Digital Flexible Partial | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 164 | Digital Flexible Partial Unilateral | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 165 | Valplast RPD (not including teeth | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 166 | Digital Valplast RPD- one shot includes teeth | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 167 | Clasp Added to Existing Frame | 3 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 168 | Anterior Teeth, Ivoclar Phonares (1 x 6) | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 169 | Posterior Teeth, Ivoclar Phonares (1 x 8) | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 170 | Anterior Teeth, Ivoclar Blue-Line(1 x 6) | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 171 | Posterior Teeth, Ivoclar Blue-Line(1 x 8) | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 172 | Anterior Teeth, Ivoclar Ivostar (1 x 6) | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 173 | Posterior Teeth, Ivoclar Nathostar(1 x 8) | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 174 | Anterior Teeth, Ivoclar Phonares(per tooth) | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 175 | Posterior Teeth, Ivoclar Phonares(per tooth) | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 176 | Anterior Teeth, Ivoclar Blue-Line(per tooth) | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 177 | Posterior Teeth, Ivoclar Blue-Line(per tooth) | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 178 | Anterior Teeth, Ivoclar Ivostar(per tooth) | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 179 | Posterior Teeth, Ivoclar Nathostar (per tooth) | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 180 | Rebase Denture | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 181 | Custom tray | 7 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 182 | Acrylic nightgaurd | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 183 | Thermoformed hard/soft night guard | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 184 | Digital 3D Printed Nightguard | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 185 | Cementing | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 186 | Removable Attachment | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 187 | Digital Milled Nightguard | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 188 | Model Free Clearsplint nightguard | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 189 | Hard night guard | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 190 | Set Up Per Tooth | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 191 | Wire Clasp C | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 192 | Ball Clasp | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 193 | Weld | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 194 | Additional Weld | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 195 | Process clear base | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 196 | Metal Backing | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 197 | Set Attachment | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 198 | P.D. Attachment | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 199 | Complex acrylic repair | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 200 | Repair Fracture | 6 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 201 | Replace existing tooth | 10 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 202 | Cure Attachment to Partial/Denture | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 203 | Add Wire Mesh | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 204 | Add Strengthener Bar | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 205 | Clear/Flexible Clasp | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 206 | Over-Denture Tooth Gasket | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 207 | TMJ Guard | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 208 | Gnatho Splint | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 209 | Essix Splint | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 210 | Talon Splint | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 211 | TAP Appliance | 4 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 212 | I Dent guide | 1 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 213 | Implant model surgery | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 214 | Map and Wax for implant placement | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 215 | Surgical Stint | 2 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 216 | Optional sleep apnea appliance | 11 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 217 | EA | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| TOTAL | CLIN 0001 | CLIN 1001 | CLIN 2001 | CLIN 3001 | CLIN 4001 |
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
GRAND TOTAL $0.00
File details come from the government source that posted it. Updated .