Exhibit_D_Eyeglass_Price_Schedule-Event_18460.xlsx
XLSX spreadsheet 16 KB Posted
- 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 Code | Procedure Name | UNIT PRICE |
| FRAMES | ||
| V2020 | FRAMES PURCHASE | |
| V2025 | DELUXE FRAME | |
| V2025 U3 | SPECIALTY FRAME | |
| S0516 | SAFETY EYEGLASS FRAMES | |
| SINGLE VISION LENSES | ||
| V2100 | SPHERE, SINGLE VISION, PLANO TO PLUS OR MINUS 4, PER LENS | |
| V2101 | SPHERE, SINGLE VISION, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS | |
| V2102 | SPHERE,SINGLE VISION, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LENS | |
| V2103 | SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 0.12 TO 2.00 CYLINDER, PER LENS | |
| V2104 | SPHEROCYLINDER,SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS | |
| V2105 | SPHEROCYLINDER, SINGLE VISION PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS | |
| V2106 | SPHEROCYLINDER, SINGLE VISION PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D CYLINDER, PER LENS | |
| V2107 | SPHEROCYLINDER, SINGLE VISION PLUS OR MINUS 4.25D TO PLUS OR MINUS 7.00D SPHERE, .12 TO 2.00D CYLINDER, PER LENS | |
| V2108 | SPHEROCYLINDER, SINGLE VISION PLUS OR MINUS 4.25D TO PLUS OR MINUS 7.00D SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS | |
| V2109 | SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.24d TO PLUS OR MINUS 7.00d SPHERE; 4.25 TO 6.00D CYLINDER PER LENS. | |
| V2110 | SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25D TO PLUS OR MINUS 7.00D SPHERE; OVER 6.00D CYCLINGER PER LENS. | |
| V2111 | SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 0.25 TO 2.25D CYLINDER, PER LENS | |
| V2112 | SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 2.25 TO 4.00D CYLINDER, PER LENS | |
| V2113 | SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS | |
| V2114 | SPHEROCYLINDER, SINGLE VISION,SPHERE OVER PLUS OR MINUS 12.00D, PER LENS | |
| V2115 | LENTICULAR, (MYODISC),PER LENS, SINGLE VISION | |
| V2118 | ANISEIKONIC LENS, SINGLE VISION | |
| V2121 | LENTICULAR LENS, PER LENS, SINGLE VISION | |
| V2199 | NOT OTHERWISE CLASSIFIED, SINGLE VISION LENS (MAXIMUM CHARGE) | |
| BIFOCAL LENSES | ||
| V2200 | SPHERE, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D, PER LENS | |
| V2201 | SPHERE, BIFOCAL, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS | |
| V2202 | SPHERE, BIFOCAL, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LENS | |
| V2203 | SPHEROCYLINDER,BIFOCAL; PLANO TO PLUS OR MINUS 4.00D SPHERE, 0.12 TO 2.00D CYLINDER, PER LENS, | |
| V2204 | SPHEROCYLINDER, BIFOCAL; PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS, | |
| V2205 | SPHEROCYLINDER, BIFOCAL; PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS, | |
| V2206 | SPHEROCYLINDER, BIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE,OVER 6D CYLINDER, PER LENS | |
| V2207 | SPHEROCYLINDER, BIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 0.12 TO 2.00D CYLINDER, PER LENS | |
| V2208 | SPHEROCYLINDER, BIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS | |
| V2209 | SPHEROCYLINDER, BIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS | |
| V2210 | SPHEROCYLINDER, BIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, OVER 6.00D CYLINDER, PER LENS | |
| V2211 | SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12D SPHERE, 0.25 TO 2.25D CYLINDER, PER LENS | |
| V2212 | SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12D SPHERE, 2.25 TO 4.00D CYLINDER, PER LENS | |
| V2213 | SPHEROCYLINDER, BIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS | |
| V2214 | SPHEROCYLINDER, BIFOCAL,SPHERE OVER PLUS OR MINUS 12.00D,PER LENS | |
| V2215 | LENTICULAR, (MYODISC), PER LENS, BIFOCAL | |
| V2218 | ANISEIKONIC, PER LENS, BIFOCAL | |
| V2219 | BIFOCAL SEG WIDTH OVER 28MM | |
| V2220 | BIFOCAL ADD OVER 3.25D | |
| V2221 | LENTICULAR LENS, PER LENS, BIFOCAL | |
| V2299 | SPECECIALY BIFOCAL (BY REPORT) (MAXIMUM CHARGE) | |
| Procedure Code | Procedure Name | UNIT PRICE |
| TRIFOCAL LENSES | ||
| V2300 | SPHERE, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D, PER LENS | |
| V2301 | SPHERE, TRIFOCAL, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS | |
| V2302 | SPHERE, TRIFOCAL, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LENS | |
| V2303 | SPHEROCYLINDER,TRIFOCAL; PLANO TO PLUS OR MINUS 4.00D SPHERE, 0.12 TO 2.00D CYLINDER, PER LENS, | |
| V2304 | SPHEROCYLINDER, TRIFOCAL; PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.25 TO 4.00D CYLINDER, PER LENS, | |
| V2305 | SPHEROCYLINDER, TRIFOCAL; PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS, | |
| V2306 | SPHEROCYLINDER, TRIFOCAL, PLANO TO PLUS OR MINUS 4.00D SPHERE,OVER 6.00D CYLINDER, PER LENS | |
| V2307 | SPHEROCYLINDER, TRIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 0.12 TO 2.00D CYLINDER, PER LENS | |
| V2308 | SPHEROCYLINDER, TRIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS | |
| V2309 | SPHEROCYLINDER, TRIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS | |
| V2310 | SPHEROCYLINDER, TRIFOCAL ,PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D SPHERE, OVER 6.00D CYLINDER, PER LENS | |
| V2311 | SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 0.25 TO 2.25D CYLINDER, PER LENS | |
| V2312 | SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 2.25 TO 4.00D CYLINDER, PER LENS | |
| V2313 | SPHEROCYLINDER, TRIFOCAL, PLUS OR MINUS 7.25 TO PLUS OR MINUS 12.00D SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS | |
| V2314 | SPHEROCYLINDER, TRIFOCAL,SPHERE OVER PLUS OR MINUS 12.00D,PER LENS | |
| V2315 | LENTICULAR, (MYODISC) ,PER LENS,TRIFOCAL | |
| V2318 | ANISEIKONIC LENS,TRIFOCAL | |
| V2319 | TRIFOCAL SEG WIDTH OVER 28MM | |
| V2320 | TRIFOCAL ADD OVER 3.25D | |
| V2321 | LENTRICULAR LENS, PER LENS, TRIFOCAL | |
| V2399 | SPECIALTY TRIFOCAL BY REPORT (MAXIMUM CHARGE) | |
| VARIABLE ASPHERICITY | ||
| V2410 | VARIABLE ASPHERICITY LENS, SINGLE VISION, FULL FIELD, GLASS OR PLASTIC, PER LENS | |
| V2430 | VARIABLE ASPHERICITY LENS, BIFOCAL, FULL FIELD, GLASS OR PLASTIC, PER LENS | |
| V2499 | VARIABLE SPHERICITY LENS, OTHER TYPE (MAXIMUM CHARGE) | |
| MISCELLANEOUS | ||
| V2700 | BALANCE LENS,PER LENS | |
| V2710 | SLAB OFF PRISM, GLASS OR PLASTIC, PER LENS | |
| V2715 | PRISM, PER LENS | |
| V2718 | PRESS-ON LENS, FRESNEL PRISM, PER LENS | |
| V2730 | SPECIAL BASE CURVE, GLASS OR PLASTIC,PER LENS | |
| V2744 | TINT, PHOTOCHROMATIC; PER LENS | |
| V2745 | ADDITION TO LENS; TINT, ANY COLOR, SOLID GRADIENT OR EQUAL, EXCLUDES PHOTOCHROMATIC, ANY LENS MATERIAL, PER LENS | |
| V2755 | U-V LENS,PER LENS | |
| V2762 | POLARIZATION, ANY LENS MATERIAL, PER LENS | |
| V2770 | OCCLUDER LENS, PER LENS | |
| V2780 | OVERSIZE LENSES, PER LENS | |
| V2781 | PROGRESSIVE LENS, PER LENS | |
| V2782 | LENS, INDEX 1.54 TO 1.65 PLASTIC OR 1.60 TO 1.79 GLASS, EXCLUDES POLYCARBONATE, PER LENS | |
| V2783 | LENS, INDEX GREATER THAN OR EQUAL TO 1.66 PLASTIC OR GREATER THAN OR EQUAL TO 1.80 GLASS, EXCLUDES POLYCARBONATE, PER LENS | |
| V2784 | LENS, 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)
File details come from the government source that posted it. Updated .