PRICE WORKSHEET.xlsx

XLSX spreadsheet 42 KB Posted Sep 12, 2022

Attached to: Q503--Department of Veterans Affairs VA Long Beach Healthcare System Dental Services Department Dental Laboratory Services
Solicitation number: 36C26222Q1722
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 22

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36C26222Q1722_2.docx	DOCX document	Sep 22, 2022
36C26222Q1722_1.docx	DOCX document	Sep 12, 2022
WAGE DETERMINATION - LOS ANGELES COUNTY.pdf	PDF	Sep 12, 2022
36C26222Q1722.pdf	PDF	Sep 12, 2022

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San Diego Required Items

ITEM DESCRIPTION	Unit of Measure	Annual Est Qty
Metal ceramic restorations
PFM -high noble alloy[1]
PFM- Non precious alloy[1]
Single anterior PFM (#6 - 11) (esthetic case- high noble alloy[1])
Additional labor cost for splinted PFM per unit)
Pontic/Bridge PFM- high noble alloy[1]
Pontic/Bridge PFM non-precious alloy[1]
PFM Press- On-Metal technique (posteriors only)
CAPTEK crown
Maryland Bridge -high noble alloy [1]
Maryland bridge Additional Pontic -high noble alloy[1]
Additional Wing Extension Maryland bridge
Rest on crown
Guide Plane
Labor for attachment on crowns. Additional charge for attachment/component cost [2]
Solder
Post-Solder
Laser welding
Porcelain margin labor
Pink porcelain per crown unit
Metal occlusal suface for crown (labor only)
All ceramic restoration- Zirconia
Zirconia crown
Anterior zirconia crown (single crown #6-11)
Layered zirconia crown
Zirconia bridge/Pontic
IPS Empress crown
IPS empress inlay/onlay
Lava crown
Feldspathic porcelain veneer
Feldspathic porcelain inlay/onlay
e.max Crown
e.max inlay/onlay
e.max veneer
All Metal Restorations
Full Metal Crown -high noble alloy[1]
Full Metal Crown-non precious alloy[1]
Metal inlay/onlay -high noble alloy[1]
Metal inlay/onlay non-precious alloy[1]
Pontic high noble metal[1]
Cast post and dowel core[1]
Implant restorations
Implant Cement Retained PFM- high noble alloy[1]
Implant Cement Retained PFM- non-precious alloy[1]
Anterior Implant Cement Retained PFM- high noble alloy[1]
Screw Retained implant PFM [1]- high noble alloy[1] (Additional charge for implant components [2])
Screw Retained anterior implant PFM - high noble alloy[1] (Additional charge for implant components [2])
Screw Retained implant high noble metal crown[1]
(Additional charge for implant components [2])
Additional labor cost for splinted implant PFM per unit
Zirconia cement retained implant crown
Zirconia screw retained implant crown
e.max crown cement retained implant crown
Implant hybrid prosthesis (case complete include metal bar 3-6 implants, process, denture teeth)
CAD/CAM milled titanium bar for implants (3-6 implants)
Cast implant metal bar labor only. (Additional charge for alloy[1] and components[2])
Implant abutments
Titanium/Zirconia abutment preparation (labor only)
Titanium abutment, CAD/CAM milled
Gold hue titanium abutment (CAD/CAM milled)
Cast custom abutment/UCLA abutment - (Additional charge for alloy[1] and components[2])
Zirconia abutment, CAD/CAM milled
Zirconia on titanium base abutment
Implant stents/index
Surgical stent
Surgical stent with CT markers
Abutment placement guide/stent/index
Other services
Shade Take/Custom shade
Provisional/Temporary crown per unit
Provisional/Temporary crown with fiber/wire reinforcement per unit
Provisional/Temporary implant crown per unit
Diagnostic Wax Up per unit
Pour stone model
Pindex model
Pour stone model with soft tissue
Bleaching tray
Custom tray
REMOVABLE LAB PROCEDURES[3]
Acrylic Partial Plus Teeth and Clasps 1-3 teeth
Acrylic Partial Plus Teeth and Clasps 4-6 teeth
Acrylic Partial Plus Teeth and Clasps 7-14 teeth
Flex partial denture (Valplast) includes teeth
Flex partial denture (Valplast) with metal frame work
Vitalium partial denture plus teeth (start to finish include custom tray, record base, set up teeth, process and finish)
Vitalium partial denture frame work only
Full denture (Luciton 199 , from start to finish include custom tray, record base, set up teeth, process and finish)
Denture rebase
Hard reline (lab hard reline) denture/partial
Soft reline (lab soft reline) denture/partial
Wire clasp/Ball clasp
Mesh strengthener for removable prosthesis
Repair acrylic denture regular (Crack, add acrylic to small area, loose saddle, denture broken in less than 3 pieces)
Repair denture extensive (cracks, dentures broken in 3 pieces or more)
Valplast /flex denture repair
Add or replace denture teeth per tooth (including the cost of denture teeth)
Add or replace wire clasp
Solder wrough wire clasp to metal framework
Process attachment (Hader clip, locator, ERA) in denture (Additional charge for components/attachment) [2]
Name/ID in full or partial denture
Custom tray
Record base and wax rim/bite block
Set up teeth for try-in (labor only)
Reset teeth to new bite for try-in
Process and finish denture only (heat process)
Remount jig
Characterization denture
Night guard/Occlusal guard (hard)
Night guard/Occlusal guard (soft and hard)
Night guard/ Occlusal guard (soft)
Talon occlusal/night guard
TMJ splint/Bruxism splint
Attachments (additional charge for attachment)
Locator attachments[2]
Era Attachment[2]
Zest Anchor Attachment[2]
Hader/Dolder Attachment[2]
Sleep Apnea Devices
EMA sleep apnea device
Silencer (MAD device for sleep apnea)
TAP 3 (MAD device)
Obturators
Radiation Shield
Nasal prosthesis
Auricular (ear) prosthesis
Orbital prosthesis
Ocular prosthesis
Facial prosthesis
Feeding aid
Palatal lift prosthesis
Speech aid prosthesis
Surgical stent
Surgical splint
Tongue depressor/bite opener

Loma Linda Required Items

ITEM DESCRIPTION	Unit of Measure	Annual Est Qty
PORCELAIN FUSED TO METAL
Semi-precious metal (white) WL-1
Metal Lingual
Metal Collar Margin
Porcelain Margin
Fit to Partial
Rest Prep
Cingulum Rest Semi Precious
Porcelain Fused to White High Noble
IMPLANT
Implant Crowns PFM (white) semi-precious
Implant Crowns PFM (White) High Noble
Implant Crowns – Full Cast High Noble
Stauman Abut. Titanium PFM Semi-Precious
Custom UCLA Abutment PFM to White High Noble
Custom UCLA Abutment PFM to W. Semi-Precious
Custom UCLA Abutment Full Cast High Noble
ALL PORCELAIN
Distal Guide Plane Zirconia
IPS Emax – Layered
IPS Emax – Stained
IPS Emax – Inlay/Onlay – Stained
IPS Emax – Maryland Bridge
IPS Emax - Veneer
Mesial Rest Zirconia
Mesial Guide Sleeve
Full Contour Solid High Translucency Zirconia
Full Contour Solid Zirconia
Metal Occlusal Semi-Precious
Metal Occlusal White High Noble
Mesial Guide Plane Semi-Precious
Medial Rest Semi-Precious
Mesial Rest High Noble
Biocare-Implant Abutment Titanium PFM
Biocare-Abut, Titanium High Noble
FULL CAST CROWN
Gold Crown (Plus Metal)
Full Cast High Noble Crown Over Single Stage
Full Cast White Semi-Precious
Full Cast Yellow Semi-Precious
Myerson Ema Sleep Apnea Device
Pink Porcelain Gingival Color
PMMA Temporary
Temporary Crown
Distal Guide Plane Semi-Precious
ATTACHMENTS (PLUS COST OF ATTACHMENT)
P.D. Attachments
Distal Rest Semi-Precious
Atlantis Abutment Titanium PFM Semi-Precious
Cast Post Semi-Precious
Acrylic Stay-Plate 1-2 Teeth
Acrylic Stay-Plate 3-7 Teeth
Acrylic Stay-Plate 8 or More Teeth
Attachment Labor Removable
PFM Semi-Precious Crown Over Single Stage
PFM White High Noble Crown Over Single Stage
ACRYLIC
Hard Night Guard Hand Wax Clear Acrylic
Diagnostic Wax-Up
Economy Denture Without Bite Block
Stent-Clear Surgical Guide
Vacuum Formed Stent of Diagnostic Wax-Up
Zirconia Custom Hand-Layered Porcelain

Base Year

CLIN	ITEM DESCRIPTION	Unit of Measure	Annual Est Qty	Unit Price	Extended Price
	METAL CERAMIC
0001	PFM High Alloy	EA	50
0002	PFM Non P unit	EA	0
0003	Sing Ant PFM 6-11H	EA	40
0004	Acrylic Splint PFM	EA	0
0005	Pontic FPD High	EA	40
0006	Pontic FPD Non Prec	EA	0
0007	Maryland FPD High	EA	2
0008	Milled Plane Rest	EA	0
0009	Drill Guide	EA	0
0010	Bite Block only C&B	EA	0
0011	Porc margin	EA	0
0012	Metal occ/lingual added	EA	5
0013	Custom Abutment TiCADCAM	EA	5
	ALL CERAMIC
0014	ZIRCONIA Full Contour	EA	50
0015	Porc to Zirconia 6-11 Ant	EA	50
0016	Zirc FPD Pontic	EA	20
0017	Porcelain to Zirconia Crn	EA	5
0018	Porcelain Gingiva	EA	0
0019	LAVA crn	EA	10
0020	EMAX Crn	EA	50
0021	EMAX inlay-onlay	EA	5
0022	EMAX Veneer	EA	50
	ALL METAL
0023	FGC Full High unit	EA	50
0024	Full Metal NonP unit	EA	0
0025	Metal inlay-onlay High	EA	0
0026	Metal inlay-onlay NonP	EA	0
0027	Pontic Metal Noble	EA	5
0028	Cast post/dowel core	EA	10
	IMPLANT REST
0029	Implant Cmt PFM High	EA	10
0030	Implant Cmt PFM Nonp	EA	0
0031	Ant Imp Cem High	EA	10
0032	Screw Imp PFM High	EA	20
0033	Screw ANT Imp High	EA	10
0034	Screw Imp PFM High	EA	10
0035	Implant Screw Full Metal	EA	0
0036	ZIRCONIA Cement crn	EA	5
0037	ZIRCONIA Screw crn	EA	10
0038	EMAX Screw Imp Crn	EA	10
0039	PROCERA Milled Bar	EA	0
0040	Screw Access Hole	EA	0
0041	Soft tissue model/Implant model	EA	5
0042	Implant model w/Analog	EA	5
	IMPLANT ABUTMENT
0043	Titanium Insert	EA	0
0044	Titanium Abut CAD/CAM mil	EA	5
0045	Cast custom abutment	EA	10
0046	Zirc Abut Cad/Cam mill	EA	5
0047	Zirconia Abutment	EA	5
0048	SYNOCTA Custom Abutment	EA	10
	IMPLANT STENTS/index
0049	Surgical stent	EA	100
0050	surgical stent w/CT markers	EA	100
0051	Abut placemt guide/stent	EA	100
	OTHER SERVICES
0052	Shade/take Custom shade	EA	20
0053	Provisional/temp unit	EA	50
0054	Diagnostic Wax up per unit	EA	200
0055	Pour stone model	EA	100
0056	Pour wet impress	EA	0
0057	Bleach/Fluoride tray	EA	100
0058	Custom tray	EA	50
0059	Articulation/Mount model	EA	200
0060	Fit to Partial Labor	EA	0
0061	Coping addtl	EA	0
0062	Wax Rim C&B	EA	100
0063	Porcelain Repair	EA	100
0064	Misc Cast	EA	50
0065	Add contact charge	EA	50
0066	Replace Analog	EA	50
0067	Set up only	EA	50
0068	Process Labor only	EA	200
	REMOVABLE LAB PROC.
0069	Acrylic Partial/teeth clasp 1-3	EA	100
0070	Acrylic Partial/teeth clasp 4-6	EA	100
0071	Acrylic Part teeth/clasp 7-14	EA	100
0072	VALPLAST flex part w/teeth	EA	200
0073	VALPLAST flex part metal FW	EA	10
0074	VALPLAST Process finish	EA	200
0075	VALPLAST-Addtl teeth	EA	50
0076	VALPLAST wax up	EA	50
0077	Partial Framework per arch	EA	100
0078	Full/Complete Dentures	EA	300
0079	Denture rebase	EA	50
0080	Hard reline	EA	100
0081	Soft reline	EA	50
0082	Wire clasp/SS/Ball clasp unit	EA	50
0083	Mesh strength removable	EA	100
0084	Repair acry dent small <$100	EA	100
0085	Repair dent extensive >$100	EA	100
0086	VALPALST-flex repair	EA	100
0087	Addtl repl teeth per tooth/repair	EA	100
0088	Addtl repl wire clasp/rest	EA	100
0089	Solder wrough wire clasp FW	EA	50
0090	Name ID in denture (F/F)	EA	0
0091	Custom TRAY denture	EA	200
0092	Wax rim/Base Plate	EA	500
0093	Reset teeth new bite tryin	EA	100
0094	Process Partial Finish teeth incl	EA	100
0095	Lucisoft Gasket	EA	0
0096	HARD nightguard/Occ	EA	200
0097	FLEXEZE/Occ hard-soft	EA	300
0098	SOFT nightguard/Occ	EA	50
0099	BRUXEZE Nightguard	EA	200
0100	TMJ splint/BRUXISM guard	EA	200
	ATTACHEMENTS ADDTL
0101	Locator attachments	EA	100
0102	HADER attach/Housing/Kit parts	EA	20
	SLEEP APNEA DEVICE (EXCEL)
0103	OBTURATOR	EA	5
0104	Bite tongue Positioner-Obturator	EA	5
0105	Radiation Shield/Bolus	EA	0
TOTAL PRICE				$

Option Year One

CLIN	ITEM DESCRIPTION	Unit of Measure	Annual Est Qty	Unit Price	Extended Price
	METAL CERAMIC
0001	PFM High Alloy	EA	50
0002	PFM Non P unit	EA	0
0003	Sing Ant PFM 6-11H	EA	40
0004	Acrylic Splint PFM	EA	0
0005	Pontic FPD High	EA	40
0006	Pontic FPD Non Prec	EA	0
0007	Maryland FPD High	EA	2
0008	Milled Plane Rest	EA	0
0009	Drill Guide	EA	0
0010	Bite Block only C&B	EA	0
0011	Porc margin	EA	0
0012	Metal occ/lingual added	EA	5
0013	Custom Abutment TiCADCAM	EA	5
	ALL CERAMIC
0014	ZIRCONIA Full Contour	EA	50
0015	Porc to Zirconia 6-11 Ant	EA	50
0016	Zirc FPD Pontic	EA	20
0017	Porcelain to Zirconia Crn	EA	5
0018	Porcelain Gingiva	EA	0
0019	LAVA crn	EA	10
0020	EMAX Crn	EA	50
0021	EMAX inlay-onlay	EA	5
0022	EMAX Veneer	EA	50
	ALL METAL
0023	FGC Full High unit	EA	50
0024	Full Metal NonP unit	EA	0
0025	Metal inlay-onlay High	EA	0
0026	Metal inlay-onlay NonP	EA	0
0027	Pontic Metal Noble	EA	5
0028	Cast post/dowel core	EA	10
	IMPLANT REST
0029	Implant Cmt PFM High	EA	10
0030	Implant Cmt PFM Nonp	EA	0
0031	Ant Imp Cem High	EA	10
0032	Screw Imp PFM High	EA	20
0033	Screw ANT Imp High	EA	10
0034	Screw Imp PFM High	EA	10
0035	Implant Screw Full Metal	EA	0
0036	ZIRCONIA Cement crn	EA	5
0037	ZIRCONIA Screw crn	EA	10
0038	EMAX Screw Imp Crn	EA	10
0039	PROCERA Milled Bar	EA	0
0040	Screw Access Hole	EA	0
0041	Soft tissue model/Implant model	EA	5
0042	Implant model w/Analog	EA	5
	IMPLANT ABUTMENT
0043	Titanium Insert	EA	0
0044	Titanium Abut CAD/CAM mil	EA	5
0045	Cast custom abutment	EA	10
0046	Zirc Abut Cad/Cam mill	EA	5
0047	Zirconia Abutment	EA	5
0048	SYNOCTA Custom Abutment	EA	10
	IMPLANT STENTS/index
0049	Surgical stent	EA	100
0050	surgical stent w/CT markers	EA	100
0051	Abut placemt guide/stent	EA	100
	OTHER SERVICES
0052	Shade/take Custom shade	EA	20
0053	Provisional/temp unit	EA	50
0054	Diagnostic Wax up per unit	EA	200
0055	Pour stone model	EA	100
0056	Pour wet impress	EA	0
0057	Bleach/Fluoride tray	EA	100
0058	Custom tray	EA	50
0059	Articulation/Mount model	EA	200
0060	Fit to Partial Labor	EA	0
0061	Coping addtl	EA	0
0062	Wax Rim C&B	EA	100
0063	Porcelain Repair	EA	100
0064	Misc Cast	EA	50
0065	Add contact charge	EA	50
0066	Replace Analog	EA	50
0067	Set up only	EA	50
0068	Process Labor only	EA	200
	REMOVABLE LAB PROC.
0069	Acrylic Partial/teeth clasp 1-3	EA	100
0070	Acrylic Partial/teeth clasp 4-6	EA	100
0071	Acrylic Part teeth/clasp 7-14	EA	100
0072	VALPLAST flex part w/teeth	EA	200
0073	VALPLAST flex part metal FW	EA	10
0074	VALPLAST Process finish	EA	200
0075	VALPLAST-Addtl teeth	EA	50
0076	VALPLAST wax up	EA	50
0077	Partial Framework per arch	EA	100
0078	Full/Complete Dentures	EA	300
0079	Denture rebase	EA	50
0080	Hard reline	EA	100
0081	Soft reline	EA	50
0082	Wire clasp/SS/Ball clasp unit	EA	50
0083	Mesh strength removable	EA	100
0084	Repair acry dent small <$100	EA	100
0085	Repair dent extensive >$100	EA	100
0086	VALPALST-flex repair	EA	100
0087	Addtl repl teeth per tooth/repair	EA	100
0088	Addtl repl wire clasp/rest	EA	100
0089	Solder wrough wire clasp FW	EA	50
0090	Name ID in denture (F/F)	EA	0
0091	Custom TRAY denture	EA	200
0092	Wax rim/Base Plate	EA	500
0093	Reset teeth new bite tryin	EA	100
0094	Process Partial Finish teeth incl	EA	100
0095	Lucisoft Gasket	EA	0
0096	HARD nightguard/Occ	EA	200
0097	FLEXEZE/Occ hard-soft	EA	300
0098	SOFT nightguard/Occ	EA	50
0099	BRUXEZE Nightguard	EA	200
0100	TMJ splint/BRUXISM guard	EA	200
	ATTACHEMENTS ADDTL
0101	Locator attachments	EA	100
0102	HADER attach/Housing/Kit parts	EA	20
	SLEEP APNEA DEVICE (EXCEL)
0103	OBTURATOR	EA	5
0104	Bite tongue Positioner-Obturator	EA	5
0105	Radiation Shield/Bolus	EA	0
TOTAL PRICE				$

Option Year Two

CLIN	ITEM DESCRIPTION	Unit of Measure	Annual Est Qty	Unit Price	Extended Price
	METAL CERAMIC
0001	PFM High Alloy	EA	50
0002	PFM Non P unit	EA	0
0003	Sing Ant PFM 6-11H	EA	40
0004	Acrylic Splint PFM	EA	0
0005	Pontic FPD High	EA	40
0006	Pontic FPD Non Prec	EA	0
0007	Maryland FPD High	EA	2
0008	Milled Plane Rest	EA	0
0009	Drill Guide	EA	0
0010	Bite Block only C&B	EA	0
0011	Porc margin	EA	0
0012	Metal occ/lingual added	EA	5
0013	Custom Abutment TiCADCAM	EA	5
	ALL CERAMIC
0014	ZIRCONIA Full Contour	EA	50
0015	Porc to Zirconia 6-11 Ant	EA	50
0016	Zirc FPD Pontic	EA	20
0017	Porcelain to Zirconia Crn	EA	5
0018	Porcelain Gingiva	EA	0
0019	LAVA crn	EA	10
0020	EMAX Crn	EA	50
0021	EMAX inlay-onlay	EA	5
0022	EMAX Veneer	EA	50
	ALL METAL
0023	FGC Full High unit	EA	50
0024	Full Metal NonP unit	EA	0
0025	Metal inlay-onlay High	EA	0
0026	Metal inlay-onlay NonP	EA	0
0027	Pontic Metal Noble	EA	5
0028	Cast post/dowel core	EA	10
	IMPLANT REST
0029	Implant Cmt PFM High	EA	10
0030	Implant Cmt PFM Nonp	EA	0
0031	Ant Imp Cem High	EA	10
0032	Screw Imp PFM High	EA	20
0033	Screw ANT Imp High	EA	10
0034	Screw Imp PFM High	EA	10
0035	Implant Screw Full Metal	EA	0
0036	ZIRCONIA Cement crn	EA	5
0037	ZIRCONIA Screw crn	EA	10
0038	EMAX Screw Imp Crn	EA	10
0039	PROCERA Milled Bar	EA	0
0040	Screw Access Hole	EA	0
0041	Soft tissue model/Implant model	EA	5
0042	Implant model w/Analog	EA	5
	IMPLANT ABUTMENT
0043	Titanium Insert	EA	0
0044	Titanium Abut CAD/CAM mil	EA	5
0045	Cast custom abutment	EA	10
0046	Zirc Abut Cad/Cam mill	EA	5
0047	Zirconia Abutment	EA	5
0048	SYNOCTA Custom Abutment	EA	10
	IMPLANT STENTS/index
0049	Surgical stent	EA	100
0050	surgical stent w/CT markers	EA	100
0051	Abut placemt guide/stent	EA	100
	OTHER SERVICES
0052	Shade/take Custom shade	EA	20
0053	Provisional/temp unit	EA	50
0054	Diagnostic Wax up per unit	EA	200
0055	Pour stone model	EA	100
0056	Pour wet impress	EA	0
0057	Bleach/Fluoride tray	EA	100
0058	Custom tray	EA	50
0059	Articulation/Mount model	EA	200
0060	Fit to Partial Labor	EA	0
0061	Coping addtl	EA	0
0062	Wax Rim C&B	EA	100
0063	Porcelain Repair	EA	100
0064	Misc Cast	EA	50
0065	Add contact charge	EA	50
0066	Replace Analog	EA	50
0067	Set up only	EA	50
0068	Process Labor only	EA	200
	REMOVABLE LAB PROC.
0069	Acrylic Partial/teeth clasp 1-3	EA	100
0070	Acrylic Partial/teeth clasp 4-6	EA	100
0071	Acrylic Part teeth/clasp 7-14	EA	100
0072	VALPLAST flex part w/teeth	EA	200
0073	VALPLAST flex part metal FW	EA	10
0074	VALPLAST Process finish	EA	200
0075	VALPLAST-Addtl teeth	EA	50
0076	VALPLAST wax up	EA	50
0077	Partial Framework per arch	EA	100
0078	Full/Complete Dentures	EA	300
0079	Denture rebase	EA	50
0080	Hard reline	EA	100
0081	Soft reline	EA	50
0082	Wire clasp/SS/Ball clasp unit	EA	50
0083	Mesh strength removable	EA	100
0084	Repair acry dent small <$100	EA	100
0085	Repair dent extensive >$100	EA	100
0086	VALPALST-flex repair	EA	100
0087	Addtl repl teeth per tooth/repair	EA	100
0088	Addtl repl wire clasp/rest	EA	100
0089	Solder wrough wire clasp FW	EA	50
0090	Name ID in denture (F/F)	EA	0
0091	Custom TRAY denture	EA	200
0092	Wax rim/Base Plate	EA	500
0093	Reset teeth new bite tryin	EA	100
0094	Process Partial Finish teeth incl	EA	100
0095	Lucisoft Gasket	EA	0
0096	HARD nightguard/Occ	EA	200
0097	FLEXEZE/Occ hard-soft	EA	300
0098	SOFT nightguard/Occ	EA	50
0099	BRUXEZE Nightguard	EA	200
0100	TMJ splint/BRUXISM guard	EA	200
	ATTACHEMENTS ADDTL
0101	Locator attachments	EA	100
0102	HADER attach/Housing/Kit parts	EA	20
	SLEEP APNEA DEVICE (EXCEL)
0103	OBTURATOR	EA	5
0104	Bite tongue Positioner-Obturator	EA	5
0105	Radiation Shield/Bolus	EA	0
TOTAL PRICE				$

Option Year Three

CLIN	ITEM DESCRIPTION	Unit of Measure	Annual Est Qty	Unit Price	Extended Price
	METAL CERAMIC
0001	PFM High Alloy	EA	50
0002	PFM Non P unit	EA	0
0003	Sing Ant PFM 6-11H	EA	40
0004	Acrylic Splint PFM	EA	0
0005	Pontic FPD High	EA	40
0006	Pontic FPD Non Prec	EA	0
0007	Maryland FPD High	EA	2
0008	Milled Plane Rest	EA	0
0009	Drill Guide	EA	0
0010	Bite Block only C&B	EA	0
0011	Porc margin	EA	0
0012	Metal occ/lingual added	EA	5
0013	Custom Abutment TiCADCAM	EA	5
	ALL CERAMIC
0014	ZIRCONIA Full Contour	EA	50
0015	Porc to Zirconia 6-11 Ant	EA	50
0016	Zirc FPD Pontic	EA	20
0017	Porcelain to Zirconia Crn	EA	5
0018	Porcelain Gingiva	EA	0
0019	LAVA crn	EA	10
0020	EMAX Crn	EA	50
0021	EMAX inlay-onlay	EA	5
0022	EMAX Veneer	EA	50
	ALL METAL
0023	FGC Full High unit	EA	50
0024	Full Metal NonP unit	EA	0
0025	Metal inlay-onlay High	EA	0
0026	Metal inlay-onlay NonP	EA	0
0027	Pontic Metal Noble	EA	5
0028	Cast post/dowel core	EA	10
	IMPLANT REST
0029	Implant Cmt PFM High	EA	10
0030	Implant Cmt PFM Nonp	EA	0
0031	Ant Imp Cem High	EA	10
0032	Screw Imp PFM High	EA	20
0033	Screw ANT Imp High	EA	10
0034	Screw Imp PFM High	EA	10
0035	Implant Screw Full Metal	EA	0
0036	ZIRCONIA Cement crn	EA	5
0037	ZIRCONIA Screw crn	EA	10
0038	EMAX Screw Imp Crn	EA	10
0039	PROCERA Milled Bar	EA	0
0040	Screw Access Hole	EA	0
0041	Soft tissue model/Implant model	EA	5
0042	Implant model w/Analog	EA	5
	IMPLANT ABUTMENT
0043	Titanium Insert	EA	0
0044	Titanium Abut CAD/CAM mil	EA	5
0045	Cast custom abutment	EA	10
0046	Zirc Abut Cad/Cam mill	EA	5
0047	Zirconia Abutment	EA	5
0048	SYNOCTA Custom Abutment	EA	10
	IMPLANT STENTS/index
0049	Surgical stent	EA	100
0050	surgical stent w/CT markers	EA	100
0051	Abut placemt guide/stent	EA	100
	OTHER SERVICES
0052	Shade/take Custom shade	EA	20
0053	Provisional/temp unit	EA	50
0054	Diagnostic Wax up per unit	EA	200
0055	Pour stone model	EA	100
0056	Pour wet impress	EA	0
0057	Bleach/Fluoride tray	EA	100
0058	Custom tray	EA	50
0059	Articulation/Mount model	EA	200
0060	Fit to Partial Labor	EA	0
0061	Coping addtl	EA	0
0062	Wax Rim C&B	EA	100
0063	Porcelain Repair	EA	100
0064	Misc Cast	EA	50
0065	Add contact charge	EA	50
0066	Replace Analog	EA	50
0067	Set up only	EA	50
0068	Process Labor only	EA	200
	REMOVABLE LAB PROC.
0069	Acrylic Partial/teeth clasp 1-3	EA	100
0070	Acrylic Partial/teeth clasp 4-6	EA	100
0071	Acrylic Part teeth/clasp 7-14	EA	100
0072	VALPLAST flex part w/teeth	EA	200
0073	VALPLAST flex part metal FW	EA	10
0074	VALPLAST Process finish	EA	200
0075	VALPLAST-Addtl teeth	EA	50
0076	VALPLAST wax up	EA	50
0077	Partial Framework per arch	EA	100
0078	Full/Complete Dentures	EA	300
0079	Denture rebase	EA	50
0080	Hard reline	EA	100
0081	Soft reline	EA	50
0082	Wire clasp/SS/Ball clasp unit	EA	50
0083	Mesh strength removable	EA	100
0084	Repair acry dent small <$100	EA	100
0085	Repair dent extensive >$100	EA	100
0086	VALPALST-flex repair	EA	100
0087	Addtl repl teeth per tooth/repair	EA	100
0088	Addtl repl wire clasp/rest	EA	100
0089	Solder wrough wire clasp FW	EA	50
0090	Name ID in denture (F/F)	EA	0
0091	Custom TRAY denture	EA	200
0092	Wax rim/Base Plate	EA	500
0093	Reset teeth new bite tryin	EA	100
0094	Process Partial Finish teeth incl	EA	100
0095	Lucisoft Gasket	EA	0
0096	HARD nightguard/Occ	EA	200
0097	FLEXEZE/Occ hard-soft	EA	300
0098	SOFT nightguard/Occ	EA	50
0099	BRUXEZE Nightguard	EA	200
0100	TMJ splint/BRUXISM guard	EA	200
	ATTACHEMENTS ADDTL
0101	Locator attachments	EA	100
0102	HADER attach/Housing/Kit parts	EA	20
	SLEEP APNEA DEVICE (EXCEL)
0103	OBTURATOR	EA	5
0104	Bite tongue Positioner-Obturator	EA	5
0105	Radiation Shield/Bolus	EA	0
TOTAL PRICE				$

Option Year Four

CLIN	ITEM DESCRIPTION	Unit of Measure	Annual Est Qty	Unit Price	Extended Price
	METAL CERAMIC
0001	PFM High Alloy	EA	50
0002	PFM Non P unit	EA	0
0003	Sing Ant PFM 6-11H	EA	40
0004	Acrylic Splint PFM	EA	0
0005	Pontic FPD High	EA	40
0006	Pontic FPD Non Prec	EA	0
0007	Maryland FPD High	EA	2
0008	Milled Plane Rest	EA	0
0009	Drill Guide	EA	0
0010	Bite Block only C&B	EA	0
0011	Porc margin	EA	0
0012	Metal occ/lingual added	EA	5
0013	Custom Abutment TiCADCAM	EA	5
	ALL CERAMIC
0014	ZIRCONIA Full Contour	EA	50
0015	Porc to Zirconia 6-11 Ant	EA	50
0016	Zirc FPD Pontic	EA	20
0017	Porcelain to Zirconia Crn	EA	5
0018	Porcelain Gingiva	EA	0
0019	LAVA crn	EA	10
0020	EMAX Crn	EA	50
0021	EMAX inlay-onlay	EA	5
0022	EMAX Veneer	EA	50
	ALL METAL
0023	FGC Full High unit	EA	50
0024	Full Metal NonP unit	EA	0
0025	Metal inlay-onlay High	EA	0
0026	Metal inlay-onlay NonP	EA	0
0027	Pontic Metal Noble	EA	5
0028	Cast post/dowel core	EA	10
	IMPLANT REST
0029	Implant Cmt PFM High	EA	10
0030	Implant Cmt PFM Nonp	EA	0
0031	Ant Imp Cem High	EA	10
0032	Screw Imp PFM High	EA	20
0033	Screw ANT Imp High	EA	10
0034	Screw Imp PFM High	EA	10
0035	Implant Screw Full Metal	EA	0
0036	ZIRCONIA Cement crn	EA	5
0037	ZIRCONIA Screw crn	EA	10
0038	EMAX Screw Imp Crn	EA	10
0039	PROCERA Milled Bar	EA	0
0040	Screw Access Hole	EA	0
0041	Soft tissue model/Implant model	EA	5
0042	Implant model w/Analog	EA	5
	IMPLANT ABUTMENT
0043	Titanium Insert	EA	0
0044	Titanium Abut CAD/CAM mil	EA	5
0045	Cast custom abutment	EA	10
0046	Zirc Abut Cad/Cam mill	EA	5
0047	Zirconia Abutment	EA	5
0048	SYNOCTA Custom Abutment	EA	10
	IMPLANT STENTS/index
0049	Surgical stent	EA	100
0050	surgical stent w/CT markers	EA	100
0051	Abut placemt guide/stent	EA	100
	OTHER SERVICES
0052	Shade/take Custom shade	EA	20
0053	Provisional/temp unit	EA	50
0054	Diagnostic Wax up per unit	EA	200
0055	Pour stone model	EA	100
0056	Pour wet impress	EA	0
0057	Bleach/Fluoride tray	EA	100
0058	Custom tray	EA	50
0059	Articulation/Mount model	EA	200
0060	Fit to Partial Labor	EA	0
0061	Coping addtl	EA	0
0062	Wax Rim C&B	EA	100
0063	Porcelain Repair	EA	100
0064	Misc Cast	EA	50
0065	Add contact charge	EA	50
0066	Replace Analog	EA	50
0067	Set up only	EA	50
0068	Process Labor only	EA	200
	REMOVABLE LAB PROC.
0069	Acrylic Partial/teeth clasp 1-3	EA	100
0070	Acrylic Partial/teeth clasp 4-6	EA	100
0071	Acrylic Part teeth/clasp 7-14	EA	100
0072	VALPLAST flex part w/teeth	EA	200
0073	VALPLAST flex part metal FW	EA	10
0074	VALPLAST Process finish	EA	200
0075	VALPLAST-Addtl teeth	EA	50
0076	VALPLAST wax up	EA	50
0077	Partial Framework per arch	EA	100
0078	Full/Complete Dentures	EA	300
0079	Denture rebase	EA	50
0080	Hard reline	EA	100
0081	Soft reline	EA	50
0082	Wire clasp/SS/Ball clasp unit	EA	50
0083	Mesh strength removable	EA	100
0084	Repair acry dent small <$100	EA	100
0085	Repair dent extensive >$100	EA	100
0086	VALPALST-flex repair	EA	100
0087	Addtl repl teeth per tooth/repair	EA	100
0088	Addtl repl wire clasp/rest	EA	100
0089	Solder wrough wire clasp FW	EA	50
0090	Name ID in denture (F/F)	EA	0
0091	Custom TRAY denture	EA	200
0092	Wax rim/Base Plate	EA	500
0093	Reset teeth new bite tryin	EA	100
0094	Process Partial Finish teeth incl	EA	100
0095	Lucisoft Gasket	EA	0
0096	HARD nightguard/Occ	EA	200
0097	FLEXEZE/Occ hard-soft	EA	300
0098	SOFT nightguard/Occ	EA	50
0099	BRUXEZE Nightguard	EA	200
0100	TMJ splint/BRUXISM guard	EA	200
	ATTACHEMENTS ADDTL
0101	Locator attachments	EA	100
0102	HADER attach/Housing/Kit parts	EA	20
	SLEEP APNEA DEVICE (EXCEL)
0103	OBTURATOR	EA	5
0104	Bite tongue Positioner-Obturator	EA	5
0105	Radiation Shield/Bolus	EA	0
TOTAL PRICE				$

File details come from the government source that posted it. Updated Sep 12, 2022.