Exhibit_D_Eyeglass_Price_Schedule-Event_18460.xlsx

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Attached to
PRESCRIPTION GLASSES (LENSES, FRAMES, MATERIALS)
Solicitation number
2000018460
Issued by
Minnesota

About this file

This is a Price Schedule exhibit for a prescription eyeglasses contract solicitation issued by the State of Minnesota for the Minnesota Health Care Programs (MHCP), including Medical Assistance (MA) and MinnesotaCare, as well as other state agencies and participants in the State of Minnesota's Cooperative Purchasing Venture (CPV) program. The solicitation seeks responses from vendors to provide prescription eyeglasses, including lenses, frames, and associated materials. The contract period begins September 1, 2026, or upon contract execution (whichever is later), through August 31, 2027, or 12 months after execution, with options to extend up to 48 months upon mutual agreement. The actual program start date for order receipt and invoicing begins November 1, 2026. This contract structure accommodates both new contractors and the continuation of the existing contractor, with a seamless transition period designed to maintain program continuity.

The Price Schedule (Exhibit D) establishes unit pricing for a comprehensive range of eyeglass components and services organized by product category: frames (standard, deluxe, specialty, and safety frames); single vision lenses with varying sphere and spherocylinder prescriptions; bifocal lenses with multiple prescription ranges; trifocal lenses; variable asphericity lenses; and miscellaneous services including lens tinting, prism work, progressive lenses, UV protection, polarization, and specialty index materials. The schedule uses standardized procedure codes for billing and pricing purposes. MHCP recipients with Medicare or third-party insurance coverage are not required to use this contract. The solicitation was issued through the SWIFT Supplier Portal with responses required by a specified deadline, though the specific due date and unit prices are not displayed in this exhibit portion of the document.

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EXHIBIT D: PRICE SCHEDULE - PRESCRIPTION GASSES, (LENSES, FRAMES AND MATERIALS)
SWIFT EVENT G0210-2000018460
Procedure CodeProcedure NameUNIT PRICE
FRAMES
V2020FRAMES PURCHASE
V2025DELUXE FRAME
V2025 U3SPECIALTY FRAME
S0516SAFETY EYEGLASS FRAMES
SINGLE VISION LENSES
V2100SPHERE, SINGLE VISION, PLANO TO PLUS OR MINUS 4, PER LENS
V2101SPHERE, SINGLE VISION, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS
V2102SPHERE,SINGLE VISION, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LENS
V2103SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 0.12 TO 2.00 CYLINDER, PER LENS
V2104SPHEROCYLINDER,SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS
V2105SPHEROCYLINDER, SINGLE VISION PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS
V2106SPHEROCYLINDER, SINGLE VISION PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D CYLINDER, PER LENS
V2107SPHEROCYLINDER, SINGLE VISION PLUS OR MINUS 4.25D TO PLUS OR MINUS 7.00D SPHERE, .12 TO 2.00D CYLINDER, PER LENS
V2108SPHEROCYLINDER, SINGLE VISION PLUS OR MINUS 4.25D TO PLUS OR MINUS 7.00D SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS
V2109SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.24d TO PLUS OR MINUS 7.00d SPHERE; 4.25 TO 6.00D CYLINDER PER LENS.
V2110SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25D TO PLUS OR MINUS 7.00D SPHERE; OVER 6.00D CYCLINGER PER LENS.
V2111SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 0.25 TO 2.25D CYLINDER, PER LENS
V2112SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 2.25 TO 4.00D CYLINDER, PER LENS
V2113SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS
V2114SPHEROCYLINDER, SINGLE VISION,SPHERE OVER PLUS OR MINUS 12.00D, PER LENS
V2115LENTICULAR, (MYODISC),PER LENS, SINGLE VISION
V2118ANISEIKONIC LENS, SINGLE VISION
V2121LENTICULAR LENS, PER LENS, SINGLE VISION
V2199NOT OTHERWISE CLASSIFIED, SINGLE VISION LENS (MAXIMUM CHARGE)
BIFOCAL LENSES
V2200SPHERE, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D, PER LENS
V2201SPHERE, BIFOCAL, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS
V2202SPHERE, BIFOCAL, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LENS
V2203SPHEROCYLINDER,BIFOCAL; PLANO TO PLUS OR MINUS 4.00D SPHERE, 0.12 TO 2.00D CYLINDER, PER LENS,
V2204SPHEROCYLINDER, BIFOCAL; PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS,
V2205SPHEROCYLINDER, BIFOCAL; PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS,
V2206SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE,OVER 6D CYLINDER, PER LENS
V2207SPHEROCYLINDER, BIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 0.12 TO 2.00D CYLINDER, PER LENS
V2208SPHEROCYLINDER, BIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS
V2209SPHEROCYLINDER, BIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS
V2210SPHEROCYLINDER, BIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, OVER 6.00D CYLINDER, PER LENS
V2211SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12D SPHERE, 0.25 TO 2.25D CYLINDER, PER LENS
V2212SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12D SPHERE, 2.25 TO 4.00D CYLINDER, PER LENS
V2213SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS
V2214SPHEROCYLINDER, BIFOCAL,SPHERE OVER PLUS OR MINUS 12.00D,PER LENS
V2215LENTICULAR, (MYODISC), PER LENS, BIFOCAL
V2218ANISEIKONIC, PER LENS, BIFOCAL
V2219BIFOCAL SEG WIDTH OVER 28MM
V2220BIFOCAL ADD OVER 3.25D
V2221LENTICULAR LENS, PER LENS, BIFOCAL
V2299SPECECIALY BIFOCAL (BY REPORT) (MAXIMUM CHARGE)
Procedure CodeProcedure NameUNIT PRICE
TRIFOCAL LENSES
V2300SPHERE, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D, PER LENS
V2301SPHERE, TRIFOCAL, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS
V2302SPHERE, TRIFOCAL, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LENS
V2303SPHEROCYLINDER,TRIFOCAL; PLANO TO PLUS OR MINUS 4.00D SPHERE, 0.12 TO 2.00D CYLINDER, PER LENS,
V2304SPHEROCYLINDER, TRIFOCAL; PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.25 TO 4.00D CYLINDER, PER LENS,
V2305SPHEROCYLINDER, TRIFOCAL; PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS,
V2306SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE,OVER 6.00D CYLINDER, PER LENS
V2307SPHEROCYLINDER, TRIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 0.12 TO 2.00D CYLINDER, PER LENS
V2308SPHEROCYLINDER, TRIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS
V2309SPHEROCYLINDER, TRIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS
V2310SPHEROCYLINDER, TRIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, OVER 6.00D CYLINDER, PER LENS
V2311SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 0.25 TO 2.25D CYLINDER, PER LENS
V2312SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 2.25 TO 4.00D CYLINDER, PER LENS
V2313SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS
V2314SPHEROCYLINDER, TRIFOCAL,SPHERE OVER PLUS OR MINUS 12.00D,PER LENS
V2315LENTICULAR, (MYODISC) ,PER LENS,TRIFOCAL
V2318ANISEIKONIC LENS,TRIFOCAL
V2319TRIFOCAL SEG WIDTH OVER 28MM
V2320TRIFOCAL ADD OVER 3.25D
V2321LENTRICULAR LENS, PER LENS, TRIFOCAL
V2399SPECIALTY TRIFOCAL BY REPORT (MAXIMUM CHARGE)
VARIABLE ASPHERICITY
V2410VARIABLE ASPHERICITY LENS, SINGLE VISION, FULL FIELD, GLASS OR PLASTIC, PER LENS
V2430VARIABLE ASPHERICITY LENS, BIFOCAL, FULL FIELD, GLASS OR PLASTIC, PER LENS
V2499VARIABLE SPHERICITY LENS, OTHER TYPE (MAXIMUM CHARGE)
MISCELLANEOUS
V2700BALANCE LENS,PER LENS
V2710SLAB OFF PRISM, GLASS OR PLASTIC, PER LENS
V2715PRISM, PER LENS
V2718PRESS-ON LENS, FRESNEL PRISM, PER LENS
V2730SPECIAL BASE CURVE, GLASS OR PLASTIC,PER LENS
V2744TINT, PHOTOCHROMATIC; PER LENS
V2745ADDITION TO LENS; TINT, ANY COLOR, SOLID GRADIENT OR EQUAL, EXCLUDES PHOTOCHROMATIC, ANY LENS MATERIAL, PER LENS
V2755U-V LENS,PER LENS
V2762POLARIZATION, ANY LENS MATERIAL, PER LENS
V2770OCCLUDER LENS, PER LENS
V2780OVERSIZE LENSES, PER LENS
V2781PROGRESSIVE LENS, PER LENS
V2782LENS, INDEX 1.54 TO 1.65 PLASTIC OR 1.60 TO 1.79 GLASS, EXCLUDES POLYCARBONATE, PER LENS
V2783LENS, INDEX GREATER THAN OR EQUAL TO 1.66 PLASTIC OR GREATER THAN OR EQUAL TO 1.80 GLASS, EXCLUDES POLYCARBONATE, PER LENS
V2784LENS, POLYCARBONATE OR EQUAL, ANY INDEX, PER LENS

&"Arial,Bold"&12EXHIBIT D: PRICE SCHEDULE PRESCRIPTION EYEGLASSES

G-165(5) Prescription Eyeglasses (Lenses, Frames, and Associated Materials)

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