PRICE WORKSHEET.xlsx

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Q503--Department of Veterans Affairs VA San Diego Healthcare System Dental Services Department Dental Laboratory Services
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36C26222Q1723
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Base Year

CLINITEM DESCRIPTIONUnit of MeasureAnnual Est QtyUnit PriceExtended Price
Metal ceramic restorations
0001PFM -high noble alloy[1]EA250
0002PFM- Non precious alloy[1]EA0
0003Single anterior PFM (#6 - 11) (esthetic case- high noble alloy[1])EA20
0004Additional labor cost for splinted PFM per unit)EA30
0005Pontic/Bridge PFM- high noble alloy[1]EA25
0006Pontic/Bridge PFM non-precious alloy[1]EA0
0007PFM Press- On-Metal technique (posteriors only)EA0
0008CAPTEK crownEA0
0009Maryland Bridge -high noble alloy [1]EA10
0010Maryland bridge Additional Pontic -high noble alloy[1]EA0
0011Additional Wing Extension Maryland bridgeEA20
0012Rest on crownEA100
0013Guide PlaneEA50
0014Labor for attachment on crowns. Additional charge for attachment/component cost [2]EA0
0015SolderEA5
0016Post-SolderEA2
0017Laser weldingEA5
0018Porcelain margin laborEA100
0019Pink porcelain per crown unitEA10
0020Metal occlusal suface for crown (labor only)EA20
All ceramic restoration- Zirconia
0021Zirconia crownEA250
0022Anterior zirconia crown (single crown #6-11)EA30
0023Layered zirconia crownEA60
0024Zirconia bridge/PonticEA150
0025IPS Empress crownEA10
0026IPS empress inlay/onlayEA10
0027Lava crownEA10
0028Feldspathic porcelain veneerEA12
0029Feldspathic porcelain inlay/onlayEA5
0030e.max CrownEA24
0031e.max inlay/onlayEA12
0032e.max veneerEA5
All Metal Restorations
0033Full Metal Crown -high noble alloy[1]EA175
0034Full Metal Crown-non precious alloy[1]EA0
0035Metal inlay/onlay -high noble alloy[1]EA12
0036Metal inlay/onlay non-precious alloy[1]EA0
0037Pontic high noble metal[1]EA40
0038Cast post and dowel core[1]EA12
Implant restorations
0039Implant Cement Retained PFM- high noble alloy[1]EA60
0040Implant Cement Retained PFM- non-precious alloy[1]EA0
0041Anterior Implant Cement Retained PFM- high noble alloy[1]EA60
0042Screw Retained implant PFM [1]- high noble alloy[1] (Additional charge for implant components [2])EA40
0043Screw Retained anterior implant PFM - high noble alloy[1] (Additional charge for implant components [2])EA20
0044Screw Retained implant high noble metal crown[1]EA20
0045(Additional charge for implant components [2])EA12
0046Additional labor cost for splinted implant PFM per unitEA30
0047Zirconia cement retained implant crownEA100
0048Zirconia screw retained implant crownEA100
0049e.max crown cement retained implant crownEA12
0050Implant hybrid prosthesis (case complete include metal bar 3-6 implants, process, denture teeth)EA24
0051CAD/CAM milled titanium bar for implants (3-6 implants)EA5
0052Cast implant metal bar labor only. (Additional charge for alloy[1] and components[2])EA5
Implant abutments
0053Titanium/Zirconia abutment preparation (labor only)EA0
0054Titanium abutment, CAD/CAM milledEA24
0055Gold hue titanium abutment (CAD/CAM milled)EA0
0056Cast custom abutment/UCLA abutment - (Additional charge for alloy[1] and components[2])EA40
0057Zirconia abutment, CAD/CAM milledEA40
0058Zirconia on titanium base abutmentEA12
Implant stents/index
0058Surgical stentEA60
0059Surgical stent with CT markersEA10
0060Abutment placement guide/stent/indexEA60
Other services
0061Shade Take/Custom shadeEA2
0062Provisional/Temporary crown per unitEA12
0063Provisional/Temporary crown with fiber/wire reinforcement per unitEA0
0064Provisional/Temporary implant crown per unitEA10
0065Diagnostic Wax Up per unitEA400
0066Pour stone modelEA200
0067Pindex modelEA24
0068Pour stone model with soft tissueEA12
0069Bleaching trayEA12
0070Custom trayEA12
Removable Lab Procedures (3)
0071Acrylic Partial Plus Teeth and Clasps 1-3 teethEA360
0072Acrylic Partial Plus Teeth and Clasps 4-6 teethEA100
0073Acrylic Partial Plus Teeth and Clasps 7-14 teethEA30
0074Flex partial denture (Valplast) includes teethEA70
0075Flex partial denture (Valplast) with metal frame workEA0
0076Vitalium partial denture plus teeth (start to finish include custom tray, record base, set up teeth, process and finish)EA300
0077Vitalium partial denture frame work onlyEA20
0078Full denture (Luciton 199 , from start to finish include custom tray, record base, set up teeth, process and finish)EA300
0079Denture rebaseEA30
0080Hard reline (lab hard reline) denture/partialEA100
0081Soft reline (lab soft reline) denture/partialEA30
0082Wire clasp/Ball claspEA30
0083Mesh strengthener for removable prosthesisEA12
0084Repair acrylic denture regular (Crack, add acrylic to small area, loose saddle, denture broken in less than 3 pieces)EA100
0085Repair denture extensive (cracks, dentures broken in 3 pieces or more)EA100
0086Valplast /flex denture repairEA60
0087Add or replace denture teeth per tooth (including the cost of denture teeth)EA150
0088Add or replace wire claspEA60
0089Solder wrough wire clasp to metal frameworkEA60
0090Process attachment (Hader clip, locator, ERA) in denture (Additional charge for components/attachment) [2]EA80
0091Name/ID in full or partial dentureEA300
0092Custom trayEA12
0093Record base and wax rim/bite blockEA12
0094Set up teeth for try-in (labor only)EA50
0095Reset teeth to new bite for try-inEA100
0096Process and finish denture only (heat process)EA100
0097Remount jigEA12
0098Characterization dentureEA0
0099Night guard/Occlusal guard (hard)EA80
0100Night guard/Occlusal guard (soft and hard)EA200
0101Night guard/ Occlusal guard (soft)EA30
0102Talon occlusal/night guardEA40
0103TMJ splint/Bruxism splintEA12
Attachments (additional charge for attachment)
0104Locator attachments[2]EA50
0105Era Attachment[2]EA50
0106Zest Anchor Attachment[2]EA50
0107Hader/Dolder Attachment[2]EA20
Sleep Apnea Devices
0108EMA sleep apnea deviceEA10
0109Silencer (MAD device for sleep apnea)EA10
0110TAP 3 (MAD device)EA10
0111ObturatorsEA10
0112Radiation ShieldEA1
0113Nasal prosthesisEA0
0114Auricular (ear) prosthesisEA0
0115Orbital prosthesisEA0
0116Ocular prosthesisEA0
0117Facial prosthesisEA0
0118Feeding aidEA0
0119Palatal lift prosthesisEA0
0120Speech aid prosthesisEA0
0121Surgical stentEA1
0122Surgical splintEA1
0123Tongue depressor/bite openerEA1
TOTAL PRICE$

Option Year One

CLINITEM DESCRIPTIONUnit of MeasureAnnual Est QtyUnit PriceExtended Price
Metal ceramic restorations
0001PFM -high noble alloy[1]EA250
0002PFM- Non precious alloy[1]EA0
0003Single anterior PFM (#6 - 11) (esthetic case- high noble alloy[1])EA20
0004Additional labor cost for splinted PFM per unit)EA30
0005Pontic/Bridge PFM- high noble alloy[1]EA25
0006Pontic/Bridge PFM non-precious alloy[1]EA0
0007PFM Press- On-Metal technique (posteriors only)EA0
0008CAPTEK crownEA0
0009Maryland Bridge -high noble alloy [1]EA10
0010Maryland bridge Additional Pontic -high noble alloy[1]EA0
0011Additional Wing Extension Maryland bridgeEA20
0012Rest on crownEA100
0013Guide PlaneEA50
0014Labor for attachment on crowns. Additional charge for attachment/component cost [2]EA0
0015SolderEA5
0016Post-SolderEA2
0017Laser weldingEA5
0018Porcelain margin laborEA100
0019Pink porcelain per crown unitEA10
0020Metal occlusal suface for crown (labor only)EA20
All ceramic restoration- Zirconia
0021Zirconia crownEA250
0022Anterior zirconia crown (single crown #6-11)EA30
0023Layered zirconia crownEA60
0024Zirconia bridge/PonticEA150
0025IPS Empress crownEA10
0026IPS empress inlay/onlayEA10
0027Lava crownEA10
0028Feldspathic porcelain veneerEA12
0029Feldspathic porcelain inlay/onlayEA5
0030e.max CrownEA24
0031e.max inlay/onlayEA12
0032e.max veneerEA5
All Metal Restorations
0033Full Metal Crown -high noble alloy[1]EA175
0034Full Metal Crown-non precious alloy[1]EA0
0035Metal inlay/onlay -high noble alloy[1]EA12
0036Metal inlay/onlay non-precious alloy[1]EA0
0037Pontic high noble metal[1]EA40
0038Cast post and dowel core[1]EA12
Implant restorations
0039Implant Cement Retained PFM- high noble alloy[1]EA60
0040Implant Cement Retained PFM- non-precious alloy[1]EA0
0041Anterior Implant Cement Retained PFM- high noble alloy[1]EA60
0042Screw Retained implant PFM [1]- high noble alloy[1] (Additional charge for implant components [2])EA40
0043Screw Retained anterior implant PFM - high noble alloy[1] (Additional charge for implant components [2])EA20
0044Screw Retained implant high noble metal crown[1]EA20
0045(Additional charge for implant components [2])EA12
0046Additional labor cost for splinted implant PFM per unitEA30
0047Zirconia cement retained implant crownEA100
0048Zirconia screw retained implant crownEA100
0049e.max crown cement retained implant crownEA12
0050Implant hybrid prosthesis (case complete include metal bar 3-6 implants, process, denture teeth)EA24
0051CAD/CAM milled titanium bar for implants (3-6 implants)EA5
0052Cast implant metal bar labor only. (Additional charge for alloy[1] and components[2])EA5
Implant abutments
0053Titanium/Zirconia abutment preparation (labor only)EA0
0054Titanium abutment, CAD/CAM milledEA24
0055Gold hue titanium abutment (CAD/CAM milled)EA0
0056Cast custom abutment/UCLA abutment - (Additional charge for alloy[1] and components[2])EA40
0057Zirconia abutment, CAD/CAM milledEA40
0058Zirconia on titanium base abutmentEA12
Implant stents/index
0058Surgical stentEA60
0059Surgical stent with CT markersEA10
0060Abutment placement guide/stent/indexEA60
Other services
0061Shade Take/Custom shadeEA2
0062Provisional/Temporary crown per unitEA12
0063Provisional/Temporary crown with fiber/wire reinforcement per unitEA0
0064Provisional/Temporary implant crown per unitEA10
0065Diagnostic Wax Up per unitEA400
0066Pour stone modelEA200
0067Pindex modelEA24
0068Pour stone model with soft tissueEA12
0069Bleaching trayEA12
0070Custom trayEA12
Removable Lab Procedures (3)
0071Acrylic Partial Plus Teeth and Clasps 1-3 teethEA360
0072Acrylic Partial Plus Teeth and Clasps 4-6 teethEA100
0073Acrylic Partial Plus Teeth and Clasps 7-14 teethEA30
0074Flex partial denture (Valplast) includes teethEA70
0075Flex partial denture (Valplast) with metal frame workEA0
0076Vitalium partial denture plus teeth (start to finish include custom tray, record base, set up teeth, process and finish)EA300
0077Vitalium partial denture frame work onlyEA20
0078Full denture (Luciton 199 , from start to finish include custom tray, record base, set up teeth, process and finish)EA300
0079Denture rebaseEA30
0080Hard reline (lab hard reline) denture/partialEA100
0081Soft reline (lab soft reline) denture/partialEA30
0082Wire clasp/Ball claspEA30
0083Mesh strengthener for removable prosthesisEA12
0084Repair acrylic denture regular (Crack, add acrylic to small area, loose saddle, denture broken in less than 3 pieces)EA100
0085Repair denture extensive (cracks, dentures broken in 3 pieces or more)EA100
0086Valplast /flex denture repairEA60
0087Add or replace denture teeth per tooth (including the cost of denture teeth)EA150
0088Add or replace wire claspEA60
0089Solder wrough wire clasp to metal frameworkEA60
0090Process attachment (Hader clip, locator, ERA) in denture (Additional charge for components/attachment) [2]EA80
0091Name/ID in full or partial dentureEA300
0092Custom trayEA12
0093Record base and wax rim/bite blockEA12
0094Set up teeth for try-in (labor only)EA50
0095Reset teeth to new bite for try-inEA100
0096Process and finish denture only (heat process)EA100
0097Remount jigEA12
0098Characterization dentureEA0
0099Night guard/Occlusal guard (hard)EA80
0100Night guard/Occlusal guard (soft and hard)EA200
0101Night guard/ Occlusal guard (soft)EA30
0102Talon occlusal/night guardEA40
0103TMJ splint/Bruxism splintEA12
Attachments (additional charge for attachment)
0104Locator attachments[2]EA50
0105Era Attachment[2]EA50
0106Zest Anchor Attachment[2]EA50
0107Hader/Dolder Attachment[2]EA20
Sleep Apnea Devices
0108EMA sleep apnea deviceEA10
0109Silencer (MAD device for sleep apnea)EA10
0110TAP 3 (MAD device)EA10
0111ObturatorsEA10
0112Radiation ShieldEA1
0113Nasal prosthesisEA0
0114Auricular (ear) prosthesisEA0
0115Orbital prosthesisEA0
0116Ocular prosthesisEA0
0117Facial prosthesisEA0
0118Feeding aidEA0
0119Palatal lift prosthesisEA0
0120Speech aid prosthesisEA0
0121Surgical stentEA1
0122Surgical splintEA1
0123Tongue depressor/bite openerEA1
TOTAL PRICE$

Option Year Two

CLINITEM DESCRIPTIONUnit of MeasureAnnual Est QtyUnit PriceExtended Price
Metal ceramic restorations
0001PFM -high noble alloy[1]EA250
0002PFM- Non precious alloy[1]EA0
0003Single anterior PFM (#6 - 11) (esthetic case- high noble alloy[1])EA20
0004Additional labor cost for splinted PFM per unit)EA30
0005Pontic/Bridge PFM- high noble alloy[1]EA25
0006Pontic/Bridge PFM non-precious alloy[1]EA0
0007PFM Press- On-Metal technique (posteriors only)EA0
0008CAPTEK crownEA0
0009Maryland Bridge -high noble alloy [1]EA10
0010Maryland bridge Additional Pontic -high noble alloy[1]EA0
0011Additional Wing Extension Maryland bridgeEA20
0012Rest on crownEA100
0013Guide PlaneEA50
0014Labor for attachment on crowns. Additional charge for attachment/component cost [2]EA0
0015SolderEA5
0016Post-SolderEA2
0017Laser weldingEA5
0018Porcelain margin laborEA100
0019Pink porcelain per crown unitEA10
0020Metal occlusal suface for crown (labor only)EA20
All ceramic restoration- Zirconia
0021Zirconia crownEA250
0022Anterior zirconia crown (single crown #6-11)EA30
0023Layered zirconia crownEA60
0024Zirconia bridge/PonticEA150
0025IPS Empress crownEA10
0026IPS empress inlay/onlayEA10
0027Lava crownEA10
0028Feldspathic porcelain veneerEA12
0029Feldspathic porcelain inlay/onlayEA5
0030e.max CrownEA24
0031e.max inlay/onlayEA12
0032e.max veneerEA5
All Metal Restorations
0033Full Metal Crown -high noble alloy[1]EA175
0034Full Metal Crown-non precious alloy[1]EA0
0035Metal inlay/onlay -high noble alloy[1]EA12
0036Metal inlay/onlay non-precious alloy[1]EA0
0037Pontic high noble metal[1]EA40
0038Cast post and dowel core[1]EA12
Implant restorations
0039Implant Cement Retained PFM- high noble alloy[1]EA60
0040Implant Cement Retained PFM- non-precious alloy[1]EA0
0041Anterior Implant Cement Retained PFM- high noble alloy[1]EA60
0042Screw Retained implant PFM [1]- high noble alloy[1] (Additional charge for implant components [2])EA40
0043Screw Retained anterior implant PFM - high noble alloy[1] (Additional charge for implant components [2])EA20
0044Screw Retained implant high noble metal crown[1]EA20
0045(Additional charge for implant components [2])EA12
0046Additional labor cost for splinted implant PFM per unitEA30
0047Zirconia cement retained implant crownEA100
0048Zirconia screw retained implant crownEA100
0049e.max crown cement retained implant crownEA12
0050Implant hybrid prosthesis (case complete include metal bar 3-6 implants, process, denture teeth)EA24
0051CAD/CAM milled titanium bar for implants (3-6 implants)EA5
0052Cast implant metal bar labor only. (Additional charge for alloy[1] and components[2])EA5
Implant abutments
0053Titanium/Zirconia abutment preparation (labor only)EA0
0054Titanium abutment, CAD/CAM milledEA24
0055Gold hue titanium abutment (CAD/CAM milled)EA0
0056Cast custom abutment/UCLA abutment - (Additional charge for alloy[1] and components[2])EA40
0057Zirconia abutment, CAD/CAM milledEA40
0058Zirconia on titanium base abutmentEA12
Implant stents/index
0058Surgical stentEA60
0059Surgical stent with CT markersEA10
0060Abutment placement guide/stent/indexEA60
Other services
0061Shade Take/Custom shadeEA2
0062Provisional/Temporary crown per unitEA12
0063Provisional/Temporary crown with fiber/wire reinforcement per unitEA0
0064Provisional/Temporary implant crown per unitEA10
0065Diagnostic Wax Up per unitEA400
0066Pour stone modelEA200
0067Pindex modelEA24
0068Pour stone model with soft tissueEA12
0069Bleaching trayEA12
0070Custom trayEA12
Removable Lab Procedures (3)
0071Acrylic Partial Plus Teeth and Clasps 1-3 teethEA360
0072Acrylic Partial Plus Teeth and Clasps 4-6 teethEA100
0073Acrylic Partial Plus Teeth and Clasps 7-14 teethEA30
0074Flex partial denture (Valplast) includes teethEA70
0075Flex partial denture (Valplast) with metal frame workEA0
0076Vitalium partial denture plus teeth (start to finish include custom tray, record base, set up teeth, process and finish)EA300
0077Vitalium partial denture frame work onlyEA20
0078Full denture (Luciton 199 , from start to finish include custom tray, record base, set up teeth, process and finish)EA300
0079Denture rebaseEA30
0080Hard reline (lab hard reline) denture/partialEA100
0081Soft reline (lab soft reline) denture/partialEA30
0082Wire clasp/Ball claspEA30
0083Mesh strengthener for removable prosthesisEA12
0084Repair acrylic denture regular (Crack, add acrylic to small area, loose saddle, denture broken in less than 3 pieces)EA100
0085Repair denture extensive (cracks, dentures broken in 3 pieces or more)EA100
0086Valplast /flex denture repairEA60
0087Add or replace denture teeth per tooth (including the cost of denture teeth)EA150
0088Add or replace wire claspEA60
0089Solder wrough wire clasp to metal frameworkEA60
0090Process attachment (Hader clip, locator, ERA) in denture (Additional charge for components/attachment) [2]EA80
0091Name/ID in full or partial dentureEA300
0092Custom trayEA12
0093Record base and wax rim/bite blockEA12
0094Set up teeth for try-in (labor only)EA50
0095Reset teeth to new bite for try-inEA100
0096Process and finish denture only (heat process)EA100
0097Remount jigEA12
0098Characterization dentureEA0
0099Night guard/Occlusal guard (hard)EA80
0100Night guard/Occlusal guard (soft and hard)EA200
0101Night guard/ Occlusal guard (soft)EA30
0102Talon occlusal/night guardEA40
0103TMJ splint/Bruxism splintEA12
Attachments (additional charge for attachment)
0104Locator attachments[2]EA50
0105Era Attachment[2]EA50
0106Zest Anchor Attachment[2]EA50
0107Hader/Dolder Attachment[2]EA20
Sleep Apnea Devices
0108EMA sleep apnea deviceEA10
0109Silencer (MAD device for sleep apnea)EA10
0110TAP 3 (MAD device)EA10
0111ObturatorsEA10
0112Radiation ShieldEA1
0113Nasal prosthesisEA0
0114Auricular (ear) prosthesisEA0
0115Orbital prosthesisEA0
0116Ocular prosthesisEA0
0117Facial prosthesisEA0
0118Feeding aidEA0
0119Palatal lift prosthesisEA0
0120Speech aid prosthesisEA0
0121Surgical stentEA1
0122Surgical splintEA1
0123Tongue depressor/bite openerEA1
TOTAL PRICE$

Option Year Three

CLINITEM DESCRIPTIONUnit of MeasureAnnual Est QtyUnit PriceExtended Price
Metal ceramic restorations
0001PFM -high noble alloy[1]EA250
0002PFM- Non precious alloy[1]EA0
0003Single anterior PFM (#6 - 11) (esthetic case- high noble alloy[1])EA20
0004Additional labor cost for splinted PFM per unit)EA30
0005Pontic/Bridge PFM- high noble alloy[1]EA25
0006Pontic/Bridge PFM non-precious alloy[1]EA0
0007PFM Press- On-Metal technique (posteriors only)EA0
0008CAPTEK crownEA0
0009Maryland Bridge -high noble alloy [1]EA10
0010Maryland bridge Additional Pontic -high noble alloy[1]EA0
0011Additional Wing Extension Maryland bridgeEA20
0012Rest on crownEA100
0013Guide PlaneEA50
0014Labor for attachment on crowns. Additional charge for attachment/component cost [2]EA0
0015SolderEA5
0016Post-SolderEA2
0017Laser weldingEA5
0018Porcelain margin laborEA100
0019Pink porcelain per crown unitEA10
0020Metal occlusal suface for crown (labor only)EA20
All ceramic restoration- Zirconia
0021Zirconia crownEA250
0022Anterior zirconia crown (single crown #6-11)EA30
0023Layered zirconia crownEA60
0024Zirconia bridge/PonticEA150
0025IPS Empress crownEA10
0026IPS empress inlay/onlayEA10
0027Lava crownEA10
0028Feldspathic porcelain veneerEA12
0029Feldspathic porcelain inlay/onlayEA5
0030e.max CrownEA24
0031e.max inlay/onlayEA12
0032e.max veneerEA5
All Metal Restorations
0033Full Metal Crown -high noble alloy[1]EA175
0034Full Metal Crown-non precious alloy[1]EA0
0035Metal inlay/onlay -high noble alloy[1]EA12
0036Metal inlay/onlay non-precious alloy[1]EA0
0037Pontic high noble metal[1]EA40
0038Cast post and dowel core[1]EA12
Implant restorations
0039Implant Cement Retained PFM- high noble alloy[1]EA60
0040Implant Cement Retained PFM- non-precious alloy[1]EA0
0041Anterior Implant Cement Retained PFM- high noble alloy[1]EA60
0042Screw Retained implant PFM [1]- high noble alloy[1] (Additional charge for implant components [2])EA40
0043Screw Retained anterior implant PFM - high noble alloy[1] (Additional charge for implant components [2])EA20
0044Screw Retained implant high noble metal crown[1]EA20
0045(Additional charge for implant components [2])EA12
0046Additional labor cost for splinted implant PFM per unitEA30
0047Zirconia cement retained implant crownEA100
0048Zirconia screw retained implant crownEA100
0049e.max crown cement retained implant crownEA12
0050Implant hybrid prosthesis (case complete include metal bar 3-6 implants, process, denture teeth)EA24
0051CAD/CAM milled titanium bar for implants (3-6 implants)EA5
0052Cast implant metal bar labor only. (Additional charge for alloy[1] and components[2])EA5
Implant abutments
0053Titanium/Zirconia abutment preparation (labor only)EA0
0054Titanium abutment, CAD/CAM milledEA24
0055Gold hue titanium abutment (CAD/CAM milled)EA0
0056Cast custom abutment/UCLA abutment - (Additional charge for alloy[1] and components[2])EA40
0057Zirconia abutment, CAD/CAM milledEA40
0058Zirconia on titanium base abutmentEA12
Implant stents/index
0058Surgical stentEA60
0059Surgical stent with CT markersEA10
0060Abutment placement guide/stent/indexEA60
Other services
0061Shade Take/Custom shadeEA2
0062Provisional/Temporary crown per unitEA12
0063Provisional/Temporary crown with fiber/wire reinforcement per unitEA0
0064Provisional/Temporary implant crown per unitEA10
0065Diagnostic Wax Up per unitEA400
0066Pour stone modelEA200
0067Pindex modelEA24
0068Pour stone model with soft tissueEA12
0069Bleaching trayEA12
0070Custom trayEA12
Removable Lab Procedures (3)
0071Acrylic Partial Plus Teeth and Clasps 1-3 teethEA360
0072Acrylic Partial Plus Teeth and Clasps 4-6 teethEA100
0073Acrylic Partial Plus Teeth and Clasps 7-14 teethEA30
0074Flex partial denture (Valplast) includes teethEA70
0075Flex partial denture (Valplast) with metal frame workEA0
0076Vitalium partial denture plus teeth (start to finish include custom tray, record base, set up teeth, process and finish)EA300
0077Vitalium partial denture frame work onlyEA20
0078Full denture (Luciton 199 , from start to finish include custom tray, record base, set up teeth, process and finish)EA300
0079Denture rebaseEA30
0080Hard reline (lab hard reline) denture/partialEA100
0081Soft reline (lab soft reline) denture/partialEA30
0082Wire clasp/Ball claspEA30
0083Mesh strengthener for removable prosthesisEA12
0084Repair acrylic denture regular (Crack, add acrylic to small area, loose saddle, denture broken in less than 3 pieces)EA100
0085Repair denture extensive (cracks, dentures broken in 3 pieces or more)EA100
0086Valplast /flex denture repairEA60
0087Add or replace denture teeth per tooth (including the cost of denture teeth)EA150
0088Add or replace wire claspEA60
0089Solder wrough wire clasp to metal frameworkEA60
0090Process attachment (Hader clip, locator, ERA) in denture (Additional charge for components/attachment) [2]EA80
0091Name/ID in full or partial dentureEA300
0092Custom trayEA12
0093Record base and wax rim/bite blockEA12
0094Set up teeth for try-in (labor only)EA50
0095Reset teeth to new bite for try-inEA100
0096Process and finish denture only (heat process)EA100
0097Remount jigEA12
0098Characterization dentureEA0
0099Night guard/Occlusal guard (hard)EA80
0100Night guard/Occlusal guard (soft and hard)EA200
0101Night guard/ Occlusal guard (soft)EA30
0102Talon occlusal/night guardEA40
0103TMJ splint/Bruxism splintEA12
Attachments (additional charge for attachment)
0104Locator attachments[2]EA50
0105Era Attachment[2]EA50
0106Zest Anchor Attachment[2]EA50
0107Hader/Dolder Attachment[2]EA20
Sleep Apnea Devices
0108EMA sleep apnea deviceEA10
0109Silencer (MAD device for sleep apnea)EA10
0110TAP 3 (MAD device)EA10
0111ObturatorsEA10
0112Radiation ShieldEA1
0113Nasal prosthesisEA0
0114Auricular (ear) prosthesisEA0
0115Orbital prosthesisEA0
0116Ocular prosthesisEA0
0117Facial prosthesisEA0
0118Feeding aidEA0
0119Palatal lift prosthesisEA0
0120Speech aid prosthesisEA0
0121Surgical stentEA1
0122Surgical splintEA1
0123Tongue depressor/bite openerEA1
TOTAL PRICE$

Option Year Four

CLINITEM DESCRIPTIONUnit of MeasureAnnual Est QtyUnit PriceExtended Price
Metal ceramic restorations
0001PFM -high noble alloy[1]EA250
0002PFM- Non precious alloy[1]EA0
0003Single anterior PFM (#6 - 11) (esthetic case- high noble alloy[1])EA20
0004Additional labor cost for splinted PFM per unit)EA30
0005Pontic/Bridge PFM- high noble alloy[1]EA25
0006Pontic/Bridge PFM non-precious alloy[1]EA0
0007PFM Press- On-Metal technique (posteriors only)EA0
0008CAPTEK crownEA0
0009Maryland Bridge -high noble alloy [1]EA10
0010Maryland bridge Additional Pontic -high noble alloy[1]EA0
0011Additional Wing Extension Maryland bridgeEA20
0012Rest on crownEA100
0013Guide PlaneEA50
0014Labor for attachment on crowns. Additional charge for attachment/component cost [2]EA0
0015SolderEA5
0016Post-SolderEA2
0017Laser weldingEA5
0018Porcelain margin laborEA100
0019Pink porcelain per crown unitEA10
0020Metal occlusal suface for crown (labor only)EA20
All ceramic restoration- Zirconia
0021Zirconia crownEA250
0022Anterior zirconia crown (single crown #6-11)EA30
0023Layered zirconia crownEA60
0024Zirconia bridge/PonticEA150
0025IPS Empress crownEA10
0026IPS empress inlay/onlayEA10
0027Lava crownEA10
0028Feldspathic porcelain veneerEA12
0029Feldspathic porcelain inlay/onlayEA5
0030e.max CrownEA24
0031e.max inlay/onlayEA12
0032e.max veneerEA5
All Metal Restorations
0033Full Metal Crown -high noble alloy[1]EA175
0034Full Metal Crown-non precious alloy[1]EA0
0035Metal inlay/onlay -high noble alloy[1]EA12
0036Metal inlay/onlay non-precious alloy[1]EA0
0037Pontic high noble metal[1]EA40
0038Cast post and dowel core[1]EA12
Implant restorations
0039Implant Cement Retained PFM- high noble alloy[1]EA60
0040Implant Cement Retained PFM- non-precious alloy[1]EA0
0041Anterior Implant Cement Retained PFM- high noble alloy[1]EA60
0042Screw Retained implant PFM [1]- high noble alloy[1] (Additional charge for implant components [2])EA40
0043Screw Retained anterior implant PFM - high noble alloy[1] (Additional charge for implant components [2])EA20
0044Screw Retained implant high noble metal crown[1]EA20
0045(Additional charge for implant components [2])EA12
0046Additional labor cost for splinted implant PFM per unitEA30
0047Zirconia cement retained implant crownEA100
0048Zirconia screw retained implant crownEA100
0049e.max crown cement retained implant crownEA12
0050Implant hybrid prosthesis (case complete include metal bar 3-6 implants, process, denture teeth)EA24
0051CAD/CAM milled titanium bar for implants (3-6 implants)EA5
0052Cast implant metal bar labor only. (Additional charge for alloy[1] and components[2])EA5
Implant abutments
0053Titanium/Zirconia abutment preparation (labor only)EA0
0054Titanium abutment, CAD/CAM milledEA24
0055Gold hue titanium abutment (CAD/CAM milled)EA0
0056Cast custom abutment/UCLA abutment - (Additional charge for alloy[1] and components[2])EA40
0057Zirconia abutment, CAD/CAM milledEA40
0058Zirconia on titanium base abutmentEA12
Implant stents/index
0058Surgical stentEA60
0059Surgical stent with CT markersEA10
0060Abutment placement guide/stent/indexEA60
Other services
0061Shade Take/Custom shadeEA2
0062Provisional/Temporary crown per unitEA12
0063Provisional/Temporary crown with fiber/wire reinforcement per unitEA0
0064Provisional/Temporary implant crown per unitEA10
0065Diagnostic Wax Up per unitEA400
0066Pour stone modelEA200
0067Pindex modelEA24
0068Pour stone model with soft tissueEA12
0069Bleaching trayEA12
0070Custom trayEA12
Removable Lab Procedures (3)
0071Acrylic Partial Plus Teeth and Clasps 1-3 teethEA360
0072Acrylic Partial Plus Teeth and Clasps 4-6 teethEA100
0073Acrylic Partial Plus Teeth and Clasps 7-14 teethEA30
0074Flex partial denture (Valplast) includes teethEA70
0075Flex partial denture (Valplast) with metal frame workEA0
0076Vitalium partial denture plus teeth (start to finish include custom tray, record base, set up teeth, process and finish)EA300
0077Vitalium partial denture frame work onlyEA20
0078Full denture (Luciton 199 , from start to finish include custom tray, record base, set up teeth, process and finish)EA300
0079Denture rebaseEA30
0080Hard reline (lab hard reline) denture/partialEA100
0081Soft reline (lab soft reline) denture/partialEA30
0082Wire clasp/Ball claspEA30
0083Mesh strengthener for removable prosthesisEA12
0084Repair acrylic denture regular (Crack, add acrylic to small area, loose saddle, denture broken in less than 3 pieces)EA100
0085Repair denture extensive (cracks, dentures broken in 3 pieces or more)EA100
0086Valplast /flex denture repairEA60
0087Add or replace denture teeth per tooth (including the cost of denture teeth)EA150
0088Add or replace wire claspEA60
0089Solder wrough wire clasp to metal frameworkEA60
0090Process attachment (Hader clip, locator, ERA) in denture (Additional charge for components/attachment) [2]EA80
0091Name/ID in full or partial dentureEA300
0092Custom trayEA12
0093Record base and wax rim/bite blockEA12
0094Set up teeth for try-in (labor only)EA50
0095Reset teeth to new bite for try-inEA100
0096Process and finish denture only (heat process)EA100
0097Remount jigEA12
0098Characterization dentureEA0
0099Night guard/Occlusal guard (hard)EA80
0100Night guard/Occlusal guard (soft and hard)EA200
0101Night guard/ Occlusal guard (soft)EA30
0102Talon occlusal/night guardEA40
0103TMJ splint/Bruxism splintEA12
Attachments (additional charge for attachment)
0104Locator attachments[2]EA50
0105Era Attachment[2]EA50
0106Zest Anchor Attachment[2]EA50
0107Hader/Dolder Attachment[2]EA20
Sleep Apnea Devices
0108EMA sleep apnea deviceEA10
0109Silencer (MAD device for sleep apnea)EA10
0110TAP 3 (MAD device)EA10
0111ObturatorsEA10
0112Radiation ShieldEA1
0113Nasal prosthesisEA0
0114Auricular (ear) prosthesisEA0
0115Orbital prosthesisEA0
0116Ocular prosthesisEA0
0117Facial prosthesisEA0
0118Feeding aidEA0
0119Palatal lift prosthesisEA0
0120Speech aid prosthesisEA0
0121Surgical stentEA1
0122Surgical splintEA1
0123Tongue depressor/bite openerEA1
TOTAL PRICE$

File details come from the government source that posted it. Updated .