Updated Attachment C Pricing Sheet.pdf
PDF 175 KB Posted
- Attached to
- 358433 - Alabama Medicaid Eyewear Program
- Solicitation number
- SRC0000034489
- Issued by
- Alabama
About this file
This is a pricing sheet attachment for the Alabama Medicaid Agency's Alabama Medicaid Eyewear Program contract opportunity. The document establishes the bidding structure and pricing framework that vendors must use when submitting their proposals for providing eyewear services and products to Alabama Medicaid beneficiaries. The pricing sheet serves as the standardized template for all bidders to present their cost proposals, ensuring consistent evaluation across all submitted bids and enabling clear comparison of pricing structures among competing vendors.
The pricing sheet requires bidders to provide detailed pricing information organized by product categories and service lines relevant to the eyewear program. This includes pricing for various types of eyewear products, frames, lenses, and related services that would be provided to eligible Medicaid recipients. By utilizing this standardized attachment, the Alabama Medicaid Agency establishes transparent pricing parameters and ensures that all vendors understand the pricing expectations and format requirements for bid submission. This approach facilitates uniform cost evaluation and comparison during the procurement process.
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Text version
Attachment C
Alabama Medicaid Optical Provider Bid Sheet To Supply Eyeglasses For the Alabama Medicaid Eyewear Program
Central Source Contractor Utilization Reported from FY2023-2025
Fiscal Year of Payment
# of Recipients
Paid Amount
2023 35,344 $976,567 2024 29,097 $1,402,665 2025 27,113 $1,327,060
Name of Supplier
Address of Supplier
Address of Supplier
PRICE PER LENS X VOLUME = TOTAL COST
(CLEAR GLASS, CLEAR PLASTIC, OR CLEAR POLYCARBONATE) PER LENS
Procedure Code Procedure Code Description
Price per lens $ X Utilization =Total Cost
V2020
VISION SVCS FRAMES
PURCHASES X 32,473
V2025 EYEGLASSES DELUX FRAMES X 199
V2100 LENS SPHER SINGLE PLANO 4.00 X 9,874
V2101 SINGLE VISN SPHERE 4.12-7.00 X 680
V2102 SINGL VISN SPHERE 7.12-20.00 X 123
V2103
SPHEROCYLINDR 4.00D/12-
2.00D X 32,367
V2104 SPHEROCYLINDR 4.00D/2.12-4D X 7,260
V2105
SPHEROCYLINDER 4.00D/4.25-
6D X 1,549
V2106
SPHEROCYLINDER
4.00D/>6.00D X 96
V2107 SPHEROCYLINDER 4.25D/12-2D X 3,198
V2108
SPHEROCYLINDER 4.25D/2.12-
4D X 1,108
V2109
SPHEROCYLINDER 4.25D/4.25-
6D X 253
V2110
SPHEROCYLINDER 4.25D/OVER
6D X 19
V2111 SPHEROCYLINDR 7.25D/.25-2.25 X 604
V2112 SPHEROCYLINDR 7.25D/2.25-4D X 256
Procedure
Code Procedure Code Description Price per lens $ X Utilization =Total Cost
V2113 SPHEROCYLINDR 7.25D/4.25-6D X 47
V2114 SPHEROCYLINDER OVER 12.00D X 119
V2115
LENS LENTICULAR BIFOCAL
MYODISC SINGLE VERSION X 0
V2118 LENS ANISEIKONIC SINGLE X 0
V2121 LENTICULAR LENS, SINGLE X 2
V2199 LENS SINGLE VISION NOT OTH C X 9
V2200
LENS SPHER BIFOC PLANO
4.00D X 1,138
V2201 LENS SPHERE BIFOCAL 4.12-7.0 X 47
V2202 LENS SPHERE BIFOCAL 7.12-20. X 12
V2203 LENS SPHCYL BIFOCAL 4.00D/.1 X 5,575
V2204 LENS SPHCY BIFOCAL 4.00D/2.1 X 474
V2205 LENS SPHCY BIFOCAL 4.00D/4.2 X 51
V2206
LENS SPHCY BIFOCAL
4.00D/OVE X 9
V2207 LENS SPHCY BIFOCAL 4.25-7D/. X 297
V2208 LENS SPHCY BIFOCAL 4.25-7/2. X 63
V2209 LENS SPHCY BIFOCAL 4.25-7/4. X 11
V2210 LENS SPHCY BIFOCAL 4.25-7/OV X 2
V2211 LENS SPHCY BIFO 7.25-12/.25- X 72
V2212 LENS SPHCYL BIFO 7.25-12/2.2 X 49
V2213 LENS SPHCYL BIFO 7.25-12/4.2 X 6
V2214 LENS SPHCYL BIFOCAL OVER 12. X 34
V2215
LENS LENTICULAR BIFOCAL
MYODISC X 0
V2218 LENS ANISEIKONIC BIFOCAL X 0
V2219 LENS BIFOCAL SEG WIDTH OVER X 26
V2220 LENS BIFOCAL ADD OVER 3.25D X 29
V2221 LENTICULAR LENS, BIFOCAL X 14
V2299 LENS BIFOCAL SPECIALITY X 0
V2300 LENS SPHERE TRIFOCAL 4.00D X 8
V2301 LENS SPHERE TRIFOCAL 4.12-7 X 0
V2302 LENS SPHERE TRIFOCAL 7.12-20 X 0
V2303 LENS SPHCY TRIFOCAL 4.0/.12- X 18
V2304 LENS SPHCY TRIFOCAL 4.0/2.25 X 8
V2305 LENS SPHCY TRIFOCAL 4.0/4.25 X 0
V2306 LENS SPHCYL TRIFOCAL 4.00/>6 X 0
V2307 LENS SPHCY TRIFOCAL 4.25-7/. X 0
V2308 LENS SPHC TRIFOCAL 4.25-7/2. X 0
V2309 LENS SPHC TRIFOCAL 4.25-7/4. X 0
V2310 LENS SPHC TRIFOCAL 4.25-7/>6 X 0
V2311
LENS SPHC TRIFOCAL 7.25-
12/.25- X 0
Procedure
Code Procedure Code Description Price per lens $ X Utilization =Total Cost
V2312
LENS SPHC TRIFOCAL 7.25-
12/2.25 X 0
V2313
LENS SPHC TRIFOCAL 7.25-
12/4.25 X 0
V2314
LENS SPHCYL TRIFOCAL OVER
12 X 0
V2315 LENS LENTICULAR TRIFOCAL X 0
V2318 LENS ANISEIKONIC TRIFOCAL X 0
V2319 LENS TRIFOCAL SEG WIDTH > 28 X 0
V2320 LENS TRIFOCAL ADD OVER 3.25D X 0
V2321 LENTICULAR LENS, TRIFOCAL X 0
V2399 LENS TRIFOCAL SPECIALITY X 0
V2410 LENS VARIAB ASPHERICITY SING X 14
V2430 LENS VARIABLE ASPHERICITY BI X 0
V2499 VARIABLE ASPHERICITY LENS X 0
V2700 BALANCE LENS X 0
V2710 GLASS/PLASTIC SLAB OFF PRISM X 0
V2715 PRISM LENS/ES X 0
V2718
FRESNELL PRISM PRESS-ON
LENS X 2
V2744
TINT PHOTOCHROMATIC
LENS/ES X 10
V2745 TINT, ANY COLOR/SOLID/GRAD X 0
V2750 ANTI-REFLECTIVE COATING X 0
V2755 UV LENS/ES X 0
V2760 SCRATCH RESISTANT COATING X 0
V2780 OVERSIZE LENS/ES X 0
V2781 PROGRESSIVE LENS PER LENS X 0
V2782 LENS, 1.54-1.65 P/1.60-1.79G X 0
V2783 LENS, >= 1.66 P/>=1.80 G X 52
V2784 LENS POLYCARB OR EQUAL X 61,231
TOTAL BID PROPOSAL $
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