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DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2 Estimated Capacity & Bid Amount Calculations Hospital Beds and Related Accessories ***Please read the important information provided on page 4 before proceeding to the page(s) for a specific competitive bidding area.*** Akron, OH 4 Albany-Schenectady-Troy, NY 5 Albuquerque, NM 5 Allentown-Bethlehem-Easton, PA-NJ 6 Asheville, NC 7 Atlanta-Sandy Springs-Marietta, GA 7 Augusta-Richmond County, GA-SC 8 Austin-Round Rock-San Marcos, TX 9 Bakersfield-Delano, CA 10 Baltimore-Towson, MD 10 Baton Rouge, LA 11 Beaumont-Port Arthur, TX 12 Birmingham-Hoover, AL 12 Boise City-Nampa, ID 13 Boston-Cambridge-Quincy, MA-NH 14 Bridgeport-Stamford-Norwalk, CT 14 Bronx-Manhattan NY CBA 15 Buffalo-Niagara Falls, NY 16 Cape Coral-Fort Myers, FL 16 Central-Chicago Metro CBA 17 Charleston-North Charleston-Summerville, SC 18 Chattanooga, TN-GA 18 Colorado Springs, CO 19 Columbia, SC 20 Columbus, OH 21 Dayton, OH 21 Deltona-Daytona Beach-Ormond Beach, FL 22 Denver-Aurora-Broomfield, CO 23 Detroit-Warren-Livonia, MI 23 El Paso, TX 24

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Page 1: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

DMEPOS Competitive Bidding Program

Bid Preparation Worksheet – Round 2 Estimated Capacity & Bid Amount Calculations

Hospital Beds and Related Accessories

***Please read the important information provided on page 4 before

proceeding to the page(s) for a specific competitive bidding area.***

Akron, OH 44

Albany-Schenectady-Troy, NY 5

Albuquerque, NM 5

Allentown-Bethlehem-Easton, PA-NJ 6

Asheville, NC 7

Atlanta-Sandy Springs-Marietta, GA 7

Augusta-Richmond County, GA-SC 8

Austin-Round Rock-San Marcos, TX 9

Bakersfield-Delano, CA 10

Baltimore-Towson, MD 10

Baton Rouge, LA 11

Beaumont-Port Arthur, TX 12

Birmingham-Hoover, AL 12

Boise City-Nampa, ID 13

Boston-Cambridge-Quincy, MA-NH 14

Bridgeport-Stamford-Norwalk, CT 14

Bronx-Manhattan NY CBA 15

Buffalo-Niagara Falls, NY 16

Cape Coral-Fort Myers, FL 16

Central-Chicago Metro CBA 17

Charleston-North Charleston-Summerville, SC 18

Chattanooga, TN-GA 18

Colorado Springs, CO 19

Columbia, SC 20

Columbus, OH 21

Dayton, OH 21

Deltona-Daytona Beach-Ormond Beach, FL 22

Denver-Aurora-Broomfield, CO 23

Detroit-Warren-Livonia, MI 23

El Paso, TX 24

Page 2: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

Flint, MI 25

Fresno, CA 25

Grand Rapids-Wyoming, MI 26

Greensboro-High Point, NC 27

Greenville-Mauldin-Easley, SC 27

Hartford-West Hartford-East Hartford, CT 28

Honolulu, HI 29

Houston-Sugar Land-Baytown, TX 29

Huntington-Ashland, WV-KY-OH 30

Indiana-Chicago Metro CBA 31

Indianapolis-Carmel, IN 32

Jackson, MS 32

Jacksonville, FL 33

Knoxville, TN 34

Lakeland-Winter Haven, FL 34

Las Vegas-Paradise, NV 35

Little Rock-North Little Rock-Conway, AR 36

Los Angeles County CBA 36

Louisville/Jefferson County, KY-IN 37

McAllen-Edinburg-Mission, TX 38

Memphis, TN-MS-AR 38

Milwaukee-Waukesha-West Allis, WI 39

Minneapolis-St. Paul-Bloomington, MN-WI 40

Nashville-Davidson--Murfreesboro--Franklin, TN 40

Nassau-Brooklyn-Queens-Richmond County Metro CBA 41

New Haven-Milford, CT 42

New Orleans-Metairie-Kenner, LA 43

North East NY CBA Metro 43

North Port-Bradenton-Sarasota, FL 44

Northern NJ Metro CBA 45

Northern-Chicago Metro CBA 45

Ocala, FL 46

Oklahoma City, OK 47

Omaha-Council Bluffs, NE-IA 47

Orange County CBA 48

Oxnard-Thousand Oaks-Ventura, CA 49

Palm Bay-Melbourne-Titusville, FL 49

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 50

Page 3: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

Phoenix-Mesa-Glendale, AZ 51

Portland-Vancouver-Hillsboro, OR-WA 51

Poughkeepsie-Newburgh-Middletown, NY 52

Providence-New Bedford-Fall River, RI-MA 53

Raleigh-Cary, NC 54

Richmond, VA 54

Rochester, NY 55

Sacramento--Arden-Arcade--Roseville, CA 56

Salt Lake City, UT 56

San Antonio-New Braunfels, TX 57

San Diego-Carlsbad-San Marcos, CA 58

San Francisco-Oakland-Fremont, CA 58

San Jose-Sunnyvale-Santa Clara, CA 59

Scranton--Wilkes-Barre, PA 60

Seattle-Tacoma-Bellevue, WA 60

South-West-Chicago-Metro CBA 61

Southern NY Metro CBA 62

Springfield, MA 62

St. Louis, MO-IL 63

Stockton, CA 64

Suffolk County CBA 65

Syracuse, NY 65

Tampa-St. Petersburg-Clearwater, FL 66

Toledo, OH 67

Tucson, AZ 67

Tulsa, OK 68

Virginia Beach-Norfolk-Newport News, VA-NC 69

Visalia-Porterville, CA 69

Washington-Arlington-Alexandria, DC-VA-MD-WV 70

Wichita, KS 71

Worcester, MA 71

Youngstown-Warren-Boardman, OH-PA 72

Page 4: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

Reference Data for Background Informational

Purposes Only

Reference Data for Background Informational

Purposes Only

CBA Name HCPCSCode HCPCS Code Description Definition of

a Bidding Unit

Weight (The relative market

importance of the item in the product

category based on utilization)

2010 Beneficiary Count

(Number ofunique Medicare

beneficiaries in theCBA that receivedthe product in CY

2010)

2010 Allowed Units

(Number of unitsfor the CBA and

HCPCS code paidby Medicare in CY

2010)

Bid Limit (2012 Fee

Schedule: Bidamount must

be at or belowthis amount)

Your Cost to Purchase One (1) Unit

(Should be less than your bid

amount)

Your Bid Amount

(To provide one [1] unit as described in

Definition of a Bidding Unit;

should include cost to buy unit,

overhead and profit)

Your Estimated Capacity (Number of

units you can furnish in the

CBA for one [1]year)

Akron, OH E0260Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.7844724426 1,044 489 $1,300.40

Akron, OH E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab BarPurchase of one (1)

new unit 0.0719174689 76 35 $179.00

Akron, OH E0271 Mattress, InnerspringPurchase of one (1)

new unit 0.0363074414 13 12 $174.73

Akron, OH E0261Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0310787430 33 13 $1,267.80

Akron, OH E0940 Trapeze Bar, Free Standing, Complete With Grab BarPurchase of one (1)

new unit 0.0196838391 11 4 $321.90

Akron, OH E0303Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0154803009 31 17 $2,814.20

Akron, OH E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0065015739 13 8 $1,087.60

Akron, OH E0272 Mattress, Foam RubberPurchase of one (1)

new unit 0.0062995907 3 3 $176.47

Akron, OH E0912Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, FreeStanding, Complete With Grab Bar

Purchase of one (1) new unit 0.0058651362 10 5 $1,059.80

Akron, OH E0310 Bed Side Rails, Full LengthPurchase of one (1)

new unit 0.0057622390 1 1 $154.78

Akron, OH E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With MattressPurchase of one (1)

new unit 0.0036395094 3 1 $1,196.60

Akron, OH E0295Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Mattress

Purchase of one (1) new unit 0.0034603922 2 1 $1,178.90

Akron, OH E0305 Bed Side Rails, Half LengthPurchase of one (1)

new unit 0.0025114521 5 1 $156.40

Akron, OH E0301Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0022599258 1 1 $2,506.30

Akron, OH E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0022332487 8 3 $905.00

Akron, OH E0304Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0008155550 1 1 $7,134.80

Akron, OH E0911Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, AttachedTo Bed, With Grab Bar

Purchase of one (1) new unit 0.0007012249 1 1 $461.40

Akron, OH E0280 Bed Cradle, Any TypePurchase of one (1)

new unit 0.0005144856 1 1 $30.06

Akron, OH E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0001714952 1 1 $657.70

Product Category: Hospital Beds and Related AccessoriesBidder Data

(You will enter your estimated capacity and bid amountinformation in DBidS on Form B)

DMEPOS Competitive Bidding Bid Preparation Worksheet - Round 2Estimated Capacity & Bid Amount Calculations

This worksheet is provided to assist you with determining your bid amount and estimated capacity for each item in the product category. This information will be entered in DBidS, the online bidding system, on Form B. Your capacity is the estimated number of units that you believe you can provide in the competitive bidding area in a calendar year. All bid amounts must be bona fide (rational and feasible for you to furnish at the bid price). You must not submit a bid for an item at a loss in order to improve your chances of winning a contract. It is important for you to consider and include your cost to purchase the item, overhead, and profit when determining a bid amount for a unit. CMS will evaluate bids to verify that they are bona fide and may ask you to submit additional information, including a rationale and invoices or other documents, to validate the bid amount. Save a copy of your completed worksheet to use if CMS requests documentation to support your bid amount. Please review the Request for Bids (RFB) instructions and fact sheets for assistance with completing your bid sheet (Form B).

General Notes

* The bidding units defined in this worksheet are for bidding purposes ONLY. Please carefully review the definition of a bidding unit for each HCPCS (Healthcare Common Procedure Coding System) code and make sure you submit your bid amount correctly. Do NOT submit a rental bid amount when the definition of the bidding unit is for the purchase of a new item. The definition of a bidding unit (purchase or rental) is not necessarily an indication that this is how payment will be made for the item under the competitive bidding program.

* In all situations where a competitive bidding area (CBA) covers more than one state, the fee schedule amount for the state with the highest allowed charges (the Medicare approved amount paid for an item) for items subject to competitive bidding is used as the bid limit.

* 2010 Beneficiary Count may exceed 2010 Allowed Units because the beneficiary used the item for less than 10 months. (For bidding purposes, 10 months of rental are calculated as one unit) * Items that are currently paid on a monthly rental basis will continue to be paid on a monthly rental basis under the competitive bidding program

How Purchase Bids Will Be Converted to Rental Payments

* Capped Rental Durable Medical Equipment (DME) except power wheelchairs - single payment amount for rental months 1 - 3 based on 10 percent of purchase bids and single payment amount for rental months 4 - 13 based on 7.5 percent of purchase bids

* Power Wheelchairs - single payment amount for rental months 1 - 3 based on 15 percent of purchase bids and single payment amount for rental months 4 - 13 based on 6 percent of purchase bids * Enteral Nutrition Equipment - single payment amount for rental months 1 - 3 based on 10 percent of purchase bids and single payment amount for rental months 4 - 15 based on 7.5 percent of purchase bid

* Inexpensive or Routinely Purchased (IRP) DME - single payment amount for rental based on 10 percent of purchase of bids

The order in which HCPCS codes are presented in this worksheet is NOT NECESSARILY the order in which they will appear in Form B in DBidS. It is important that you CAREFULLY REVIEW THE DATA YOU ENTER IN DBIDS FOR ACCURACY.

Page 5: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

CBA NameHCPCS

CodeHCPCS Code Description

Definition of

a Bidding Unit

Weight (The relative market

importance of the item in the product

category based on utilization)

2010

Beneficiary

Count(Number of

unique Medicarebeneficiaries in theCBA that receivedthe product in CY

2010)

2010 Allowed

Units(Number of unitsfor the CBA and

HCPCS code paidby Medicare in CY

2010)

Bid Limit(2012 Fee

Schedule: Bidamount mustbe at or belowthis amount)

Your Cost to

Purchase

One (1) Unit (Should be less than your bid

amount)

Your Bid

Amount (To provide one [1] unit

as described in Definition of a

Bidding Unit; should include cost

to buy unit, overhead and profit)

Your

Estimated

Capacity (Number of units you

can furnish in the CBA for one [1]

year)

Akron, OH E0302Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0000952751 1 1 $6,623.40

Akron, OH E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000685981 1 1 $661.30

Akron, OH E0290 Hospital Bed, Fixed Height, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000647871 1 1 $588.10

Akron, OH E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0000419211 1 1 $665.20

Akron, OH E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any TypePurchase of one (1)

new unit 0.0000266770 1 1 $1,837.50

Akron, OH E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000228660 1 1 $562.80

Akron, OH E0291 Hospital Bed, Fixed Height, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000038110 1 1 $427.30

Albany-Schenectady-Troy, NY E0260Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.7844724426 794 366 $1,300.40

Albany-Schenectady-Troy, NY E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab BarPurchase of one (1)

new unit 0.0719174689 42 20 $185.10

Albany-Schenectady-Troy, NY E0271 Mattress, InnerspringPurchase of one (1)

new unit 0.0363074414 13 13 $174.73

Albany-Schenectady-Troy, NY E0261Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0310787430 4 3 $1,267.80

Albany-Schenectady-Troy, NY E0940 Trapeze Bar, Free Standing, Complete With Grab BarPurchase of one (1)

new unit 0.0196838391 6 3 $321.90

Albany-Schenectady-Troy, NY E0303Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0154803009 15 7 $2,734.30

Albany-Schenectady-Troy, NY E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0065015739 11 5 $1,087.60

Albany-Schenectady-Troy, NY E0272 Mattress, Foam RubberPurchase of one (1)

new unit 0.0062995907 1 1 $159.25

Albany-Schenectady-Troy, NY E0912Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Standing, Complete With Grab Bar

Purchase of one (1) new unit 0.0058651362 7 3 $1,059.80

Albany-Schenectady-Troy, NY E0310 Bed Side Rails, Full LengthPurchase of one (1)

new unit 0.0057622390 1 1 $152.77

Albany-Schenectady-Troy, NY E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With MattressPurchase of one (1)

new unit 0.0036395094 6 3 $1,209.50

Albany-Schenectady-Troy, NY E0295Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Mattress

Purchase of one (1) new unit 0.0034603922 2 1 $1,178.90

Albany-Schenectady-Troy, NY E0305 Bed Side Rails, Half LengthPurchase of one (1)

new unit 0.0025114521 4 1 $140.00

Albany-Schenectady-Troy, NY E0301Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0022599258 1 1 $2,426.50

Albany-Schenectady-Troy, NY E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0022332487 18 10 $769.30

Albany-Schenectady-Troy, NY E0304Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0008155550 1 1 $7,134.80

Albany-Schenectady-Troy, NY E0911Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached To Bed, With Grab Bar

Purchase of one (1) new unit 0.0007012249 1 1 $461.40

Albany-Schenectady-Troy, NY E0280 Bed Cradle, Any TypePurchase of one (1)

new unit 0.0005144856 1 1 $35.37

Albany-Schenectady-Troy, NY E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0001714952 1 1 $771.60

Albany-Schenectady-Troy, NY E0302Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0000952751 1 1 $6,623.40

Albany-Schenectady-Troy, NY E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000685981 1 1 $778.00

Albany-Schenectady-Troy, NY E0290 Hospital Bed, Fixed Height, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000647871 1 1 $681.70

Albany-Schenectady-Troy, NY E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0000419211 1 1 $626.00

Albany-Schenectady-Troy, NY E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any TypePurchase of one (1)

new unit 0.0000266770 1 1 $1,956.00

Albany-Schenectady-Troy, NY E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000228660 1 1 $662.10

Albany-Schenectady-Troy, NY E0291 Hospital Bed, Fixed Height, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000038110 1 1 $502.70

Albuquerque, NM E0260Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.7844724426 520 260 $1,300.40

Albuquerque, NM E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab BarPurchase of one (1)

new unit 0.0719174689 21 9 $157.30

Albuquerque, NM E0271 Mattress, InnerspringPurchase of one (1)

new unit 0.0363074414 2 1 $205.57

Albuquerque, NM E0261Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0310787430 17 8 $1,157.90

Albuquerque, NM E0940 Trapeze Bar, Free Standing, Complete With Grab BarPurchase of one (1)

new unit 0.0196838391 25 12 $274.20

Page 6: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

CBA NameHCPCS

CodeHCPCS Code Description

Definition of

a Bidding Unit

Weight (The relative market

importance of the item in the product

category based on utilization)

2010

Beneficiary

Count(Number of

unique Medicarebeneficiaries in theCBA that receivedthe product in CY

2010)

2010 Allowed

Units(Number of unitsfor the CBA and

HCPCS code paidby Medicare in CY

2010)

Bid Limit(2012 Fee

Schedule: Bidamount mustbe at or belowthis amount)

Your Cost to

Purchase

One (1) Unit (Should be less than your bid

amount)

Your Bid

Amount (To provide one [1] unit

as described in Definition of a

Bidding Unit; should include cost

to buy unit, overhead and profit)

Your

Estimated

Capacity (Number of units you

can furnish in the CBA for one [1]

year)

Albuquerque, NM E0303Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0154803009 8 3 $2,481.00

Albuquerque, NM E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0065015739 2 1 $989.40

Albuquerque, NM E0272 Mattress, Foam RubberPurchase of one (1)

new unit 0.0062995907 1 1 $187.35

Albuquerque, NM E0912Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Standing, Complete With Grab Bar

Purchase of one (1) new unit 0.0058651362 6 3 $1,059.80

Albuquerque, NM E0310 Bed Side Rails, Full LengthPurchase of one (1)

new unit 0.0057622390 1 1 $179.73

Albuquerque, NM E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With MattressPurchase of one (1)

new unit 0.0036395094 1 1 $1,184.20

Albuquerque, NM E0295Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Mattress

Purchase of one (1) new unit 0.0034603922 1 1 $1,006.10

Albuquerque, NM E0305 Bed Side Rails, Half LengthPurchase of one (1)

new unit 0.0025114521 2 1 $164.70

Albuquerque, NM E0301Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0022599258 1 1 $2,173.00

Albuquerque, NM E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0022332487 1 1 $795.10

Albuquerque, NM E0304Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0008155550 1 1 $7,134.80

Albuquerque, NM E0911Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached To Bed, With Grab Bar

Purchase of one (1) new unit 0.0007012249 1 1 $461.40

Albuquerque, NM E0280 Bed Cradle, Any TypePurchase of one (1)

new unit 0.0005144856 1 1 $30.06

Albuquerque, NM E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0001714952 1 1 $771.60

Albuquerque, NM E0302Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0000952751 1 1 $6,623.40

Albuquerque, NM E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000685981 1 1 $778.00

Albuquerque, NM E0290 Hospital Bed, Fixed Height, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000647871 1 1 $588.10

Albuquerque, NM E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0000419211 1 1 $582.90

Albuquerque, NM E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any TypePurchase of one (1)

new unit 0.0000266770 1 1 $1,763.40

Albuquerque, NM E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000228660 1 1 $658.70

Albuquerque, NM E0291 Hospital Bed, Fixed Height, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000038110 1 1 $427.30

Allentown-Bethlehem-Easton, PA-NJ E0260Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.7844724426 1,310 622 $1,300.40

Allentown-Bethlehem-Easton, PA-NJ E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab BarPurchase of one (1)

new unit 0.0719174689 41 16 $185.10

Allentown-Bethlehem-Easton, PA-NJ E0271 Mattress, InnerspringPurchase of one (1)

new unit 0.0363074414 12 12 $197.02

Allentown-Bethlehem-Easton, PA-NJ E0261Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0310787430 50 25 $1,191.00

Allentown-Bethlehem-Easton, PA-NJ E0940 Trapeze Bar, Free Standing, Complete With Grab BarPurchase of one (1)

new unit 0.0196838391 9 4 $273.60

Allentown-Bethlehem-Easton, PA-NJ E0303Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0154803009 11 5 $2,702.40

Allentown-Bethlehem-Easton, PA-NJ E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0065015739 1 1 $1,058.80

Allentown-Bethlehem-Easton, PA-NJ E0272 Mattress, Foam RubberPurchase of one (1)

new unit 0.0062995907 2 2 $180.44

Allentown-Bethlehem-Easton, PA-NJ E0912Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Standing, Complete With Grab Bar

Purchase of one (1) new unit 0.0058651362 1 1 $1,059.80

Allentown-Bethlehem-Easton, PA-NJ E0310 Bed Side Rails, Full LengthPurchase of one (1)

new unit 0.0057622390 3 1 $152.77

Allentown-Bethlehem-Easton, PA-NJ E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With MattressPurchase of one (1)

new unit 0.0036395094 34 15 $1,209.50

Allentown-Bethlehem-Easton, PA-NJ E0295Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Mattress

Purchase of one (1) new unit 0.0034603922 9 4 $1,178.90

Allentown-Bethlehem-Easton, PA-NJ E0305 Bed Side Rails, Half LengthPurchase of one (1)

new unit 0.0025114521 4 2 $148.20

Allentown-Bethlehem-Easton, PA-NJ E0301Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0022599258 5 1 $2,394.70

Allentown-Bethlehem-Easton, PA-NJ E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0022332487 2 1 $905.00

Allentown-Bethlehem-Easton, PA-NJ E0304Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0008155550 1 1 $7,134.80

Page 7: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

CBA NameHCPCS

CodeHCPCS Code Description

Definition of

a Bidding Unit

Weight (The relative market

importance of the item in the product

category based on utilization)

2010

Beneficiary

Count(Number of

unique Medicarebeneficiaries in theCBA that receivedthe product in CY

2010)

2010 Allowed

Units(Number of unitsfor the CBA and

HCPCS code paidby Medicare in CY

2010)

Bid Limit(2012 Fee

Schedule: Bidamount mustbe at or belowthis amount)

Your Cost to

Purchase

One (1) Unit (Should be less than your bid

amount)

Your Bid

Amount (To provide one [1] unit

as described in Definition of a

Bidding Unit; should include cost

to buy unit, overhead and profit)

Your

Estimated

Capacity (Number of units you

can furnish in the CBA for one [1]

year)

Allentown-Bethlehem-Easton, PA-NJ E0911Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached To Bed, With Grab Bar

Purchase of one (1) new unit 0.0007012249 1 1 $461.40

Allentown-Bethlehem-Easton, PA-NJ E0280 Bed Cradle, Any TypePurchase of one (1)

new unit 0.0005144856 1 1 $34.26

Allentown-Bethlehem-Easton, PA-NJ E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0001714952 2 1 $722.90

Allentown-Bethlehem-Easton, PA-NJ E0302Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0000952751 1 1 $6,623.40

Allentown-Bethlehem-Easton, PA-NJ E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000685981 1 1 $750.60

Allentown-Bethlehem-Easton, PA-NJ E0290 Hospital Bed, Fixed Height, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000647871 1 1 $691.90

Allentown-Bethlehem-Easton, PA-NJ E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0000419211 1 1 $685.80

Allentown-Bethlehem-Easton, PA-NJ E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any TypePurchase of one (1)

new unit 0.0000266770 1 1 $1,956.00

Allentown-Bethlehem-Easton, PA-NJ E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000228660 1 1 $662.10

Allentown-Bethlehem-Easton, PA-NJ E0291 Hospital Bed, Fixed Height, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000038110 1 1 $502.70

Asheville, NC E0260Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.7844724426 749 362 $1,300.40

Asheville, NC E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab BarPurchase of one (1)

new unit 0.0719174689 93 41 $157.30

Asheville, NC E0271 Mattress, InnerspringPurchase of one (1)

new unit 0.0363074414 10 10 $205.57

Asheville, NC E0261Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0310787430 45 19 $1,077.60

Asheville, NC E0940 Trapeze Bar, Free Standing, Complete With Grab BarPurchase of one (1)

new unit 0.0196838391 18 9 $273.60

Asheville, NC E0303Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0154803009 17 10 $2,814.20

Asheville, NC E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0065015739 3 2 $975.70

Asheville, NC E0272 Mattress, Foam RubberPurchase of one (1)

new unit 0.0062995907 2 1 $187.35

Asheville, NC E0912Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Standing, Complete With Grab Bar

Purchase of one (1) new unit 0.0058651362 5 3 $1,059.80

Asheville, NC E0310 Bed Side Rails, Full LengthPurchase of one (1)

new unit 0.0057622390 3 1 $164.67

Asheville, NC E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With MattressPurchase of one (1)

new unit 0.0036395094 1 1 $1,028.10

Asheville, NC E0295Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Mattress

Purchase of one (1) new unit 0.0034603922 1 1 $1,002.10

Asheville, NC E0305 Bed Side Rails, Half LengthPurchase of one (1)

new unit 0.0025114521 3 2 $140.00

Asheville, NC E0301Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0022599258 5 2 $2,506.30

Asheville, NC E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0022332487 1 1 $845.20

Asheville, NC E0304Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0008155550 1 1 $7,134.80

Asheville, NC E0911Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached To Bed, With Grab Bar

Purchase of one (1) new unit 0.0007012249 1 1 $461.40

Asheville, NC E0280 Bed Cradle, Any TypePurchase of one (1)

new unit 0.0005144856 1 1 $30.06

Asheville, NC E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0001714952 1 1 $736.70

Asheville, NC E0302Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0000952751 1 1 $6,623.40

Asheville, NC E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000685981 1 1 $661.30

Asheville, NC E0290 Hospital Bed, Fixed Height, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000647871 1 1 $609.20

Asheville, NC E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0000419211 1 1 $685.80

Asheville, NC E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any TypePurchase of one (1)

new unit 0.0000266770 1 1 $1,956.00

Asheville, NC E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000228660 1 1 $562.80

Asheville, NC E0291 Hospital Bed, Fixed Height, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000038110 1 1 $451.50

Atlanta-Sandy Springs-Marietta, GA E0260Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.7844724426 5,529 2,545 $1,300.40

Atlanta-Sandy Springs-Marietta, GA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab BarPurchase of one (1)

new unit 0.0719174689 425 192 $174.00

Page 8: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

CBA NameHCPCS

CodeHCPCS Code Description

Definition of

a Bidding Unit

Weight (The relative market

importance of the item in the product

category based on utilization)

2010

Beneficiary

Count(Number of

unique Medicarebeneficiaries in theCBA that receivedthe product in CY

2010)

2010 Allowed

Units(Number of unitsfor the CBA and

HCPCS code paidby Medicare in CY

2010)

Bid Limit(2012 Fee

Schedule: Bidamount mustbe at or belowthis amount)

Your Cost to

Purchase

One (1) Unit (Should be less than your bid

amount)

Your Bid

Amount (To provide one [1] unit

as described in Definition of a

Bidding Unit; should include cost

to buy unit, overhead and profit)

Your

Estimated

Capacity (Number of units you

can furnish in the CBA for one [1]

year)

Atlanta-Sandy Springs-Marietta, GA E0271 Mattress, InnerspringPurchase of one (1)

new unit 0.0363074414 131 128 $187.98

Atlanta-Sandy Springs-Marietta, GA E0261Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0310787430 271 134 $1,077.60

Atlanta-Sandy Springs-Marietta, GA E0940 Trapeze Bar, Free Standing, Complete With Grab BarPurchase of one (1)

new unit 0.0196838391 106 48 $273.60

Atlanta-Sandy Springs-Marietta, GA E0303Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0154803009 85 44 $2,735.10

Atlanta-Sandy Springs-Marietta, GA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0065015739 15 9 $932.20

Atlanta-Sandy Springs-Marietta, GA E0272 Mattress, Foam RubberPurchase of one (1)

new unit 0.0062995907 17 13 $187.35

Atlanta-Sandy Springs-Marietta, GA E0912Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Standing, Complete With Grab Bar

Purchase of one (1) new unit 0.0058651362 20 10 $1,059.80

Atlanta-Sandy Springs-Marietta, GA E0310 Bed Side Rails, Full LengthPurchase of one (1)

new unit 0.0057622390 9 6 $179.73

Atlanta-Sandy Springs-Marietta, GA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With MattressPurchase of one (1)

new unit 0.0036395094 4 1 $1,028.10

Atlanta-Sandy Springs-Marietta, GA E0295Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Mattress

Purchase of one (1) new unit 0.0034603922 6 4 $1,002.10

Atlanta-Sandy Springs-Marietta, GA E0305 Bed Side Rails, Half LengthPurchase of one (1)

new unit 0.0025114521 4 1 $140.00

Atlanta-Sandy Springs-Marietta, GA E0301Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0022599258 9 5 $2,427.40

Atlanta-Sandy Springs-Marietta, GA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0022332487 10 6 $787.90

Atlanta-Sandy Springs-Marietta, GA E0304Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0008155550 13 6 $7,134.80

Atlanta-Sandy Springs-Marietta, GA E0911Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached To Bed, With Grab Bar

Purchase of one (1) new unit 0.0007012249 1 1 $461.40

Atlanta-Sandy Springs-Marietta, GA E0280 Bed Cradle, Any TypePurchase of one (1)

new unit 0.0005144856 1 1 $35.37

Atlanta-Sandy Springs-Marietta, GA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0001714952 1 1 $655.90

Atlanta-Sandy Springs-Marietta, GA E0302Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0000952751 1 1 $6,623.40

Atlanta-Sandy Springs-Marietta, GA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000685981 1 1 $661.30

Atlanta-Sandy Springs-Marietta, GA E0290 Hospital Bed, Fixed Height, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000647871 1 1 $588.10

Atlanta-Sandy Springs-Marietta, GA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0000419211 1 1 $590.60

Atlanta-Sandy Springs-Marietta, GA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any TypePurchase of one (1)

new unit 0.0000266770 1 1 $1,956.00

Atlanta-Sandy Springs-Marietta, GA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000228660 1 1 $562.80

Atlanta-Sandy Springs-Marietta, GA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000038110 1 1 $427.30

Augusta-Richmond County, GA-SC E0260Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.7844724426 818 378 $1,300.40

Augusta-Richmond County, GA-SC E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab BarPurchase of one (1)

new unit 0.0719174689 79 36 $174.00

Augusta-Richmond County, GA-SC E0271 Mattress, InnerspringPurchase of one (1)

new unit 0.0363074414 11 10 $187.98

Augusta-Richmond County, GA-SC E0261Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0310787430 43 21 $1,077.60

Augusta-Richmond County, GA-SC E0940 Trapeze Bar, Free Standing, Complete With Grab BarPurchase of one (1)

new unit 0.0196838391 10 5 $273.60

Augusta-Richmond County, GA-SC E0303Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0154803009 15 7 $2,735.10

Augusta-Richmond County, GA-SC E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0065015739 1 1 $932.20

Augusta-Richmond County, GA-SC E0272 Mattress, Foam RubberPurchase of one (1)

new unit 0.0062995907 1 1 $187.35

Augusta-Richmond County, GA-SC E0912Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Standing, Complete With Grab Bar

Purchase of one (1) new unit 0.0058651362 4 1 $1,059.80

Augusta-Richmond County, GA-SC E0310 Bed Side Rails, Full LengthPurchase of one (1)

new unit 0.0057622390 1 1 $179.73

Augusta-Richmond County, GA-SC E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With MattressPurchase of one (1)

new unit 0.0036395094 1 1 $1,028.10

Augusta-Richmond County, GA-SC E0295Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Mattress

Purchase of one (1) new unit 0.0034603922 3 1 $1,002.10

Augusta-Richmond County, GA-SC E0305 Bed Side Rails, Half LengthPurchase of one (1)

new unit 0.0025114521 1 1 $140.00

Page 9: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Augusta-Richmond County, GA-SC E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,427.40

Purchase of one (1) Augusta-Richmond County, GA-SC E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $787.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Augusta-Richmond County, GA-SC E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Augusta-Richmond County, GA-SC E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Augusta-Richmond County, GA-SC E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Augusta-Richmond County, GA-SC E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Augusta-Richmond County, GA-SC E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Augusta-Richmond County, GA-SC E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Augusta-Richmond County, GA-SC E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Augusta-Richmond County, GA-SC E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $590.60

Purchase of one (1) Augusta-Richmond County, GA-SC E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Augusta-Richmond County, GA-SC E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Augusta-Richmond County, GA-SC E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Austin-Round Rock-San Marcos, TX E0260 Mattress new unit 0.7844724426 1,599 760 $1,300.40

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 180 93 $185.10

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0271 Mattress, Innerspring new unit 0.0363074414 22 21 $190.59

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Austin-Round Rock-San Marcos, TX E0261 Without Mattress new unit 0.0310787430 51 25 $1,267.80

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 54 26 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Austin-Round Rock-San Marcos, TX E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 40 20 $2,814.20

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 2 1 $1,087.60

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0272 Mattress, Foam Rubber new unit 0.0062995907 4 4 $171.28

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Austin-Round Rock-San Marcos, TX E0912 Standing, Complete With Grab Bar new unit 0.0058651362 17 6 $1,059.80

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0310 Bed Side Rails, Full Length new unit 0.0057622390 6 5 $168.88

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 2 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Austin-Round Rock-San Marcos, TX E0295 Mattress new unit 0.0034603922 5 3 $1,178.90

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0305 Bed Side Rails, Half Length new unit 0.0025114521 5 2 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Austin-Round Rock-San Marcos, TX E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 8 3 $2,506.30

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 5 3 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Austin-Round Rock-San Marcos, TX E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 5 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Austin-Round Rock-San Marcos, TX E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Austin-Round Rock-San Marcos, TX E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,786.50

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Page 10: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Bakersfield-Delano, CA E0260 Mattress new unit 0.7844724426 876 395 $1,300.40

Purchase of one (1) Bakersfield-Delano, CA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 100 48 $163.20

Purchase of one (1) Bakersfield-Delano, CA E0271 Mattress, Innerspring new unit 0.0363074414 15 11 $176.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Bakersfield-Delano, CA E0261 Without Mattress new unit 0.0310787430 23 6 $1,178.30

Purchase of one (1) Bakersfield-Delano, CA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 11 7 $313.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Bakersfield-Delano, CA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 10 2 $2,686.40

Purchase of one (1) Bakersfield-Delano, CA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $955.30

Purchase of one (1) Bakersfield-Delano, CA E0272 Mattress, Foam Rubber new unit 0.0062995907 7 6 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Bakersfield-Delano, CA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 2 1 $1,059.80

Purchase of one (1) Bakersfield-Delano, CA E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $176.32

Purchase of one (1) Bakersfield-Delano, CA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,150.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Bakersfield-Delano, CA E0295 Mattress new unit 0.0034603922 2 1 $1,178.90

Purchase of one (1) Bakersfield-Delano, CA E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Bakersfield-Delano, CA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 5 2 $2,378.60

Purchase of one (1) Bakersfield-Delano, CA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $837.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Bakersfield-Delano, CA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Bakersfield-Delano, CA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Bakersfield-Delano, CA E0280 Bed Cradle, Any Type new unit 0.0005144856 2 2 $35.37

Purchase of one (1) Bakersfield-Delano, CA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Bakersfield-Delano, CA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Bakersfield-Delano, CA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Bakersfield-Delano, CA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Bakersfield-Delano, CA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Bakersfield-Delano, CA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,881.00

Purchase of one (1) Bakersfield-Delano, CA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Bakersfield-Delano, CA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Baltimore-Towson, MD E0260 Mattress new unit 0.7844724426 5,038 2,374 $1,300.40

Purchase of one (1) Baltimore-Towson, MD E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 181 84 $185.10

Purchase of one (1) Baltimore-Towson, MD E0271 Mattress, Innerspring new unit 0.0363074414 48 44 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Baltimore-Towson, MD E0261 Without Mattress new unit 0.0310787430 228 98 $1,108.80

Purchase of one (1) Baltimore-Towson, MD E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 71 34 $297.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Baltimore-Towson, MD E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 78 43 $2,659.80

Purchase of one (1) Baltimore-Towson, MD E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 19 9 $1,087.60

Purchase of one (1) Baltimore-Towson, MD E0272 Mattress, Foam Rubber new unit 0.0062995907 16 16 $173.51

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Baltimore-Towson, MD E0912 Standing, Complete With Grab Bar new unit 0.0058651362 20 13 $1,059.80

Purchase of one (1) Baltimore-Towson, MD E0310 Bed Side Rails, Full Length new unit 0.0057622390 3 2 $178.59

Purchase of one (1) Baltimore-Towson, MD E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 32 16 $1,093.80

Page 11: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Baltimore-Towson, MD E0295 Mattress new unit 0.0034603922 21 14 $1,011.00

Purchase of one (1) Baltimore-Towson, MD E0305 Bed Side Rails, Half Length new unit 0.0025114521 6 4 $149.50

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Baltimore-Towson, MD E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 10 5 $2,356.80

Purchase of one (1) Baltimore-Towson, MD E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 28 12 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Baltimore-Towson, MD E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 4 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Baltimore-Towson, MD E0911 To Bed, With Grab Bar new unit 0.0007012249 4 1 $461.40

Purchase of one (1) Baltimore-Towson, MD E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Baltimore-Towson, MD E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $760.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Baltimore-Towson, MD E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Baltimore-Towson, MD E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $745.00

Purchase of one (1) Baltimore-Towson, MD E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Baltimore-Towson, MD E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Baltimore-Towson, MD E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,908.60

Purchase of one (1) Baltimore-Towson, MD E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Baltimore-Towson, MD E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Baton Rouge, LA E0260 Mattress new unit 0.7844724426 1,078 503 $1,300.50

Purchase of one (1) Baton Rouge, LA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 84 44 $173.70

Purchase of one (1) Baton Rouge, LA E0271 Mattress, Innerspring new unit 0.0363074414 9 8 $178.16

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Baton Rouge, LA E0261 Without Mattress new unit 0.0310787430 28 14 $1,267.80

Purchase of one (1) Baton Rouge, LA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 23 10 $273.60

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Baton Rouge, LA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 21 12 $2,643.10

Purchase of one (1) Baton Rouge, LA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,017.20

Purchase of one (1) Baton Rouge, LA E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Baton Rouge, LA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 6 4 $1,059.80

Purchase of one (1) Baton Rouge, LA E0310 Bed Side Rails, Full Length new unit 0.0057622390 3 3 $179.73

Purchase of one (1) Baton Rouge, LA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 6 3 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Baton Rouge, LA E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Baton Rouge, LA E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Baton Rouge, LA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 3 1 $2,335.10

Purchase of one (1) Baton Rouge, LA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $777.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Baton Rouge, LA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Baton Rouge, LA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Baton Rouge, LA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Baton Rouge, LA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Baton Rouge, LA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Baton Rouge, LA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Baton Rouge, LA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Baton Rouge, LA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $640.00

Page 12: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Baton Rouge, LA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,803.00

Purchase of one (1) Baton Rouge, LA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Baton Rouge, LA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Beaumont-Port Arthur, TX E0260 Mattress new unit 0.7844724426 742 335 $1,300.40

Purchase of one (1) Beaumont-Port Arthur, TX E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 108 50 $185.10

Purchase of one (1) Beaumont-Port Arthur, TX E0271 Mattress, Innerspring new unit 0.0363074414 11 11 $190.59

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Beaumont-Port Arthur, TX E0261 Without Mattress new unit 0.0310787430 21 8 $1,267.80

Purchase of one (1) Beaumont-Port Arthur, TX E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 24 9 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Beaumont-Port Arthur, TX E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 15 7 $2,814.20

Purchase of one (1) Beaumont-Port Arthur, TX E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,087.60

Purchase of one (1) Beaumont-Port Arthur, TX E0272 Mattress, Foam Rubber new unit 0.0062995907 2 2 $171.28

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Beaumont-Port Arthur, TX E0912 Standing, Complete With Grab Bar new unit 0.0058651362 10 6 $1,059.80

Purchase of one (1) Beaumont-Port Arthur, TX E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $168.88

Purchase of one (1) Beaumont-Port Arthur, TX E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Beaumont-Port Arthur, TX E0295 Mattress new unit 0.0034603922 2 1 $1,178.90

Purchase of one (1) Beaumont-Port Arthur, TX E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Beaumont-Port Arthur, TX E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 4 2 $2,506.30

Purchase of one (1) Beaumont-Port Arthur, TX E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Beaumont-Port Arthur, TX E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Beaumont-Port Arthur, TX E0911 To Bed, With Grab Bar new unit 0.0007012249 3 1 $461.40

Purchase of one (1) Beaumont-Port Arthur, TX E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Beaumont-Port Arthur, TX E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Beaumont-Port Arthur, TX E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Beaumont-Port Arthur, TX E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Beaumont-Port Arthur, TX E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Beaumont-Port Arthur, TX E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Beaumont-Port Arthur, TX E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,786.50

Purchase of one (1) Beaumont-Port Arthur, TX E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Beaumont-Port Arthur, TX E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Birmingham-Hoover, AL E0260 Mattress new unit 0.7844724426 1,671 748 $1,300.40

Purchase of one (1) Birmingham-Hoover, AL E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 196 86 $157.30

Purchase of one (1) Birmingham-Hoover, AL E0271 Mattress, Innerspring new unit 0.0363074414 22 21 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Birmingham-Hoover, AL E0261 Without Mattress new unit 0.0310787430 94 43 $1,077.60

Purchase of one (1) Birmingham-Hoover, AL E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 64 30 $273.60

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Birmingham-Hoover, AL E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 26 15 $2,683.70

Purchase of one (1) Birmingham-Hoover, AL E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 3 1 $924.50

Purchase of one (1) Birmingham-Hoover, AL E0272 Mattress, Foam Rubber new unit 0.0062995907 5 5 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Birmingham-Hoover, AL E0912 Standing, Complete With Grab Bar new unit 0.0058651362 6 2 $1,059.80

Page 13: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Birmingham-Hoover, AL E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $164.84

Purchase of one (1) Birmingham-Hoover, AL E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Birmingham-Hoover, AL E0295 Mattress new unit 0.0034603922 3 1 $1,002.10

Purchase of one (1) Birmingham-Hoover, AL E0305 Bed Side Rails, Half Length new unit 0.0025114521 4 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Birmingham-Hoover, AL E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 6 2 $2,376.10

Purchase of one (1) Birmingham-Hoover, AL E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 2 1 $769.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Birmingham-Hoover, AL E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Birmingham-Hoover, AL E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Birmingham-Hoover, AL E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Birmingham-Hoover, AL E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Birmingham-Hoover, AL E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Birmingham-Hoover, AL E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Birmingham-Hoover, AL E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Birmingham-Hoover, AL E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $582.90

Purchase of one (1) Birmingham-Hoover, AL E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Birmingham-Hoover, AL E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Birmingham-Hoover, AL E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Boise City-Nampa, ID E0260 Mattress new unit 0.7844724426 344 163 $1,300.40

Purchase of one (1) Boise City-Nampa, ID E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 11 5 $171.90

Purchase of one (1) Boise City-Nampa, ID E0271 Mattress, Innerspring new unit 0.0363074414 3 3 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Boise City-Nampa, ID E0261 Without Mattress new unit 0.0310787430 3 1 $1,267.80

Purchase of one (1) Boise City-Nampa, ID E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 6 3 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Boise City-Nampa, ID E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 6 1 $2,814.20

Purchase of one (1) Boise City-Nampa, ID E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 8 3 $924.50

Purchase of one (1) Boise City-Nampa, ID E0272 Mattress, Foam Rubber new unit 0.0062995907 2 2 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Boise City-Nampa, ID E0912 Standing, Complete With Grab Bar new unit 0.0058651362 3 1 $1,059.80

Purchase of one (1) Boise City-Nampa, ID E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $160.37

Purchase of one (1) Boise City-Nampa, ID E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Boise City-Nampa, ID E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Boise City-Nampa, ID E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $157.10

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Boise City-Nampa, ID E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,506.30

Purchase of one (1) Boise City-Nampa, ID E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 2 1 $852.20

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Boise City-Nampa, ID E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Boise City-Nampa, ID E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Boise City-Nampa, ID E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $33.18

Purchase of one (1) Boise City-Nampa, ID E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $705.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Boise City-Nampa, ID E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Boise City-Nampa, ID E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $713.00

Page 14: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Boise City-Nampa, ID E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $643.20

Purchase of one (1) Boise City-Nampa, ID E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $652.10

Purchase of one (1) Boise City-Nampa, ID E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,863.40

Purchase of one (1) Boise City-Nampa, ID E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $575.40

Purchase of one (1) Boise City-Nampa, ID E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $459.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0260 Mattress new unit 0.7844724426 4,645 2,163 $1,300.40

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 156 83 $185.10

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0271 Mattress, Innerspring new unit 0.0363074414 119 116 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0261 Without Mattress new unit 0.0310787430 158 62 $1,267.80

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 39 18 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 58 32 $2,814.20

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 34 16 $1,087.60

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0272 Mattress, Foam Rubber new unit 0.0062995907 9 9 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0912 Standing, Complete With Grab Bar new unit 0.0058651362 13 6 $1,059.80

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0310 Bed Side Rails, Full Length new unit 0.0057622390 13 5 $171.28

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 6 3 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0295 Mattress new unit 0.0034603922 119 64 $1,178.90

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0305 Bed Side Rails, Half Length new unit 0.0025114521 97 53 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 11 4 $2,506.30

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 10 6 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 3 2 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0280 Bed Cradle, Any Type new unit 0.0005144856 6 6 $33.86

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0260 Mattress new unit 0.7844724426 1,134 527 $1,300.30

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 24 11 $185.10

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0271 Mattress, Innerspring new unit 0.0363074414 73 73 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0261 Without Mattress new unit 0.0310787430 314 145 $1,267.80

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 12 5 $318.30

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 9 5 $2,814.20

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 4 1 $1,087.60

Page 15: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0912 Standing, Complete With Grab Bar new unit 0.0058651362 1 1 $1,059.80

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0310 Bed Side Rails, Full Length new unit 0.0057622390 9 7 $179.73

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0295 Mattress new unit 0.0034603922 1 1 $1,011.00

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,506.30

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Bronx-Manhattan NY CBA E0260 Mattress new unit 0.7844724426 3,920 2,066 $1,300.40

Purchase of one (1) Bronx-Manhattan NY CBA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 84 48 $185.10

Purchase of one (1) Bronx-Manhattan NY CBA E0271 Mattress, Innerspring new unit 0.0363074414 87 84 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Bronx-Manhattan NY CBA E0261 Without Mattress new unit 0.0310787430 153 71 $1,267.80

Purchase of one (1) Bronx-Manhattan NY CBA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 28 14 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Bronx-Manhattan NY CBA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 36 18 $2,734.30

Purchase of one (1) Bronx-Manhattan NY CBA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 5 1 $1,087.60

Purchase of one (1) Bronx-Manhattan NY CBA E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Bronx-Manhattan NY CBA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 8 4 $1,059.80

Purchase of one (1) Bronx-Manhattan NY CBA E0310 Bed Side Rails, Full Length new unit 0.0057622390 41 46 $152.77

Purchase of one (1) Bronx-Manhattan NY CBA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 5 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Bronx-Manhattan NY CBA E0295 Mattress new unit 0.0034603922 2 1 $1,178.90

Purchase of one (1) Bronx-Manhattan NY CBA E0305 Bed Side Rails, Half Length new unit 0.0025114521 7 4 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Bronx-Manhattan NY CBA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 3 1 $2,426.50

Purchase of one (1) Bronx-Manhattan NY CBA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 5 2 $769.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Bronx-Manhattan NY CBA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Bronx-Manhattan NY CBA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Bronx-Manhattan NY CBA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Bronx-Manhattan NY CBA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Page 16: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Bronx-Manhattan NY CBA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Bronx-Manhattan NY CBA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Bronx-Manhattan NY CBA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $681.70

Purchase of one (1) Bronx-Manhattan NY CBA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $626.00

Purchase of one (1) Bronx-Manhattan NY CBA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Bronx-Manhattan NY CBA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Bronx-Manhattan NY CBA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Buffalo-Niagara Falls, NY E0260 Mattress new unit 0.7844724426 719 365 $1,300.40

Purchase of one (1) Buffalo-Niagara Falls, NY E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 29 17 $185.10

Purchase of one (1) Buffalo-Niagara Falls, NY E0271 Mattress, Innerspring new unit 0.0363074414 19 18 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Buffalo-Niagara Falls, NY E0261 Without Mattress new unit 0.0310787430 4 2 $1,267.80

Purchase of one (1) Buffalo-Niagara Falls, NY E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 10 4 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Buffalo-Niagara Falls, NY E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 16 10 $2,734.30

Purchase of one (1) Buffalo-Niagara Falls, NY E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,087.60

Purchase of one (1) Buffalo-Niagara Falls, NY E0272 Mattress, Foam Rubber new unit 0.0062995907 2 2 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Buffalo-Niagara Falls, NY E0912 Standing, Complete With Grab Bar new unit 0.0058651362 3 1 $1,059.80

Purchase of one (1) Buffalo-Niagara Falls, NY E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 2 $152.77

Purchase of one (1) Buffalo-Niagara Falls, NY E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 16 9 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Buffalo-Niagara Falls, NY E0295 Mattress new unit 0.0034603922 8 5 $1,178.90

Purchase of one (1) Buffalo-Niagara Falls, NY E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Buffalo-Niagara Falls, NY E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 2 1 $2,426.50

Purchase of one (1) Buffalo-Niagara Falls, NY E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 5 1 $769.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Buffalo-Niagara Falls, NY E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 3 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Buffalo-Niagara Falls, NY E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Buffalo-Niagara Falls, NY E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Buffalo-Niagara Falls, NY E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Buffalo-Niagara Falls, NY E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Buffalo-Niagara Falls, NY E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Buffalo-Niagara Falls, NY E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $681.70

Purchase of one (1) Buffalo-Niagara Falls, NY E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $626.00

Purchase of one (1) Buffalo-Niagara Falls, NY E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Buffalo-Niagara Falls, NY E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Buffalo-Niagara Falls, NY E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Cape Coral-Fort Myers, FL E0260 Mattress new unit 0.7844724426 747 337 $1,300.40

Purchase of one (1) Cape Coral-Fort Myers, FL E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 36 16 $185.10

Purchase of one (1) Cape Coral-Fort Myers, FL E0271 Mattress, Innerspring new unit 0.0363074414 6 5 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Cape Coral-Fort Myers, FL E0261 Without Mattress new unit 0.0310787430 13 5 $1,077.60

Purchase of one (1) Cape Coral-Fort Myers, FL E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 11 5 $285.30

Page 17: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Cape Coral-Fort Myers, FL E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 4 2 $2,736.10

Purchase of one (1) Cape Coral-Fort Myers, FL E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 14 7 $1,039.50

Purchase of one (1) Cape Coral-Fort Myers, FL E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $176.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Cape Coral-Fort Myers, FL E0912 Standing, Complete With Grab Bar new unit 0.0058651362 1 1 $1,059.80

Purchase of one (1) Cape Coral-Fort Myers, FL E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 1 $170.25

Purchase of one (1) Cape Coral-Fort Myers, FL E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Cape Coral-Fort Myers, FL E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Cape Coral-Fort Myers, FL E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Cape Coral-Fort Myers, FL E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,428.00

Purchase of one (1) Cape Coral-Fort Myers, FL E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 3 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Cape Coral-Fort Myers, FL E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Cape Coral-Fort Myers, FL E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Cape Coral-Fort Myers, FL E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $34.26

Purchase of one (1) Cape Coral-Fort Myers, FL E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $730.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Cape Coral-Fort Myers, FL E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Cape Coral-Fort Myers, FL E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $731.90

Purchase of one (1) Cape Coral-Fort Myers, FL E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Cape Coral-Fort Myers, FL E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Cape Coral-Fort Myers, FL E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Cape Coral-Fort Myers, FL E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $623.20

Purchase of one (1) Cape Coral-Fort Myers, FL E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Central-Chicago Metro CBA E0260 Mattress new unit 0.7844724426 10,160 4,862 $1,300.40

Purchase of one (1) Central-Chicago Metro CBA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 579 287 $185.10

Purchase of one (1) Central-Chicago Metro CBA E0271 Mattress, Innerspring new unit 0.0363074414 203 196 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Central-Chicago Metro CBA E0261 Without Mattress new unit 0.0310787430 777 386 $1,267.80

Purchase of one (1) Central-Chicago Metro CBA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 169 87 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Central-Chicago Metro CBA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 212 119 $2,814.20

Purchase of one (1) Central-Chicago Metro CBA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 177 83 $1,087.60

Purchase of one (1) Central-Chicago Metro CBA E0272 Mattress, Foam Rubber new unit 0.0062995907 10 8 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Central-Chicago Metro CBA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 73 38 $1,059.80

Purchase of one (1) Central-Chicago Metro CBA E0310 Bed Side Rails, Full Length new unit 0.0057622390 8 10 $163.72

Purchase of one (1) Central-Chicago Metro CBA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 7 4 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Central-Chicago Metro CBA E0295 Mattress new unit 0.0034603922 4 1 $1,178.90

Purchase of one (1) Central-Chicago Metro CBA E0305 Bed Side Rails, Half Length new unit 0.0025114521 11 5 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Central-Chicago Metro CBA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 18 8 $2,506.30

Purchase of one (1) Central-Chicago Metro CBA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 3 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Central-Chicago Metro CBA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 4 1 $7,134.80

Page 18: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Central-Chicago Metro CBA E0911 To Bed, With Grab Bar new unit 0.0007012249 15 8 $461.40

Purchase of one (1) Central-Chicago Metro CBA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Central-Chicago Metro CBA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 23 9 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Central-Chicago Metro CBA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Central-Chicago Metro CBA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Central-Chicago Metro CBA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Central-Chicago Metro CBA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 3 1 $685.80

Purchase of one (1) Central-Chicago Metro CBA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 6 1 $1,799.00

Purchase of one (1) Central-Chicago Metro CBA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Central-Chicago Metro CBA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $433.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Charleston-North Charleston-Summerville, SC E0260 Mattress new unit 0.7844724426 1,040 481 $1,300.40

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 92 45 $185.10

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0271 Mattress, Innerspring new unit 0.0363074414 28 28 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Charleston-North Charleston-Summerville, SC E0261 Without Mattress new unit 0.0310787430 35 13 $1,077.60

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 28 10 $273.60

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Charleston-North Charleston-Summerville, SC E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 4 2 $2,715.40

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $924.50

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0272 Mattress, Foam Rubber new unit 0.0062995907 2 2 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Charleston-North Charleston-Summerville, SC E0912 Standing, Complete With Grab Bar new unit 0.0058651362 8 4 $1,059.80

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0310 Bed Side Rails, Full Length new unit 0.0057622390 5 4 $179.73

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Charleston-North Charleston-Summerville, SC E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0305 Bed Side Rails, Half Length new unit 0.0025114521 4 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Charleston-North Charleston-Summerville, SC E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,407.70

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $789.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Charleston-North Charleston-Summerville, SC E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Charleston-North Charleston-Summerville, SC E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Charleston-North Charleston-Summerville, SC E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $603.30

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $582.90

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Chattanooga, TN-GA E0260 Mattress new unit 0.7844724426 1,080 507 $1,300.40

Purchase of one (1) Chattanooga, TN-GA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 135 63 $174.00

Page 19: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Chattanooga, TN-GA E0271 Mattress, Innerspring new unit 0.0363074414 21 21 $187.98

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Chattanooga, TN-GA E0261 Without Mattress new unit 0.0310787430 56 21 $1,077.60

Purchase of one (1) Chattanooga, TN-GA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 26 15 $273.60

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Chattanooga, TN-GA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 30 14 $2,735.10

Purchase of one (1) Chattanooga, TN-GA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 8 4 $932.20

Purchase of one (1) Chattanooga, TN-GA E0272 Mattress, Foam Rubber new unit 0.0062995907 3 3 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Chattanooga, TN-GA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 18 10 $1,059.80

Purchase of one (1) Chattanooga, TN-GA E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $179.73

Purchase of one (1) Chattanooga, TN-GA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Chattanooga, TN-GA E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Chattanooga, TN-GA E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Chattanooga, TN-GA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 4 1 $2,427.40

Purchase of one (1) Chattanooga, TN-GA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $787.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Chattanooga, TN-GA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Chattanooga, TN-GA E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) Chattanooga, TN-GA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Chattanooga, TN-GA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Chattanooga, TN-GA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Chattanooga, TN-GA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Chattanooga, TN-GA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Chattanooga, TN-GA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $590.60

Purchase of one (1) Chattanooga, TN-GA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Chattanooga, TN-GA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Chattanooga, TN-GA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Colorado Springs, CO E0260 Mattress new unit 0.7844724426 314 154 $1,300.40

Purchase of one (1) Colorado Springs, CO E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 19 11 $183.40

Purchase of one (1) Colorado Springs, CO E0271 Mattress, Innerspring new unit 0.0363074414 4 4 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Colorado Springs, CO E0261 Without Mattress new unit 0.0310787430 15 5 $1,267.80

Purchase of one (1) Colorado Springs, CO E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 9 3 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Colorado Springs, CO E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 3 1 $2,814.20

Purchase of one (1) Colorado Springs, CO E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 3 1 $1,087.60

Purchase of one (1) Colorado Springs, CO E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $182.28

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Colorado Springs, CO E0912 Standing, Complete With Grab Bar new unit 0.0058651362 1 1 $1,059.80

Purchase of one (1) Colorado Springs, CO E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $152.77

Purchase of one (1) Colorado Springs, CO E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 3 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Colorado Springs, CO E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Colorado Springs, CO E0305 Bed Side Rails, Half Length new unit 0.0025114521 2 1 $157.80

Page 20: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Colorado Springs, CO E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 3 1 $2,506.30

Purchase of one (1) Colorado Springs, CO E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $890.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Colorado Springs, CO E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Colorado Springs, CO E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Colorado Springs, CO E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Colorado Springs, CO E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Colorado Springs, CO E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Colorado Springs, CO E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Colorado Springs, CO E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Colorado Springs, CO E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $664.10

Purchase of one (1) Colorado Springs, CO E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,843.30

Purchase of one (1) Colorado Springs, CO E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Colorado Springs, CO E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Columbia, SC E0260 Mattress new unit 0.7844724426 1,153 558 $1,300.40

Purchase of one (1) Columbia, SC E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 140 65 $185.10

Purchase of one (1) Columbia, SC E0271 Mattress, Innerspring new unit 0.0363074414 19 19 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Columbia, SC E0261 Without Mattress new unit 0.0310787430 45 21 $1,077.60

Purchase of one (1) Columbia, SC E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 36 17 $273.60

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Columbia, SC E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 21 11 $2,715.40

Purchase of one (1) Columbia, SC E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 2 1 $924.50

Purchase of one (1) Columbia, SC E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Columbia, SC E0912 Standing, Complete With Grab Bar new unit 0.0058651362 19 9 $1,059.80

Purchase of one (1) Columbia, SC E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $179.73

Purchase of one (1) Columbia, SC E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Columbia, SC E0295 Mattress new unit 0.0034603922 2 1 $1,002.10

Purchase of one (1) Columbia, SC E0305 Bed Side Rails, Half Length new unit 0.0025114521 2 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Columbia, SC E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 3 1 $2,407.70

Purchase of one (1) Columbia, SC E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $789.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Columbia, SC E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Columbia, SC E0911 To Bed, With Grab Bar new unit 0.0007012249 3 1 $461.40

Purchase of one (1) Columbia, SC E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Columbia, SC E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Columbia, SC E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Columbia, SC E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Columbia, SC E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $603.30

Purchase of one (1) Columbia, SC E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $582.90

Purchase of one (1) Columbia, SC E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Columbia, SC E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Page 21: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Columbia, SC E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Columbus, OH E0260 Mattress new unit 0.7844724426 1,920 896 $1,300.40

Purchase of one (1) Columbus, OH E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 140 62 $179.00

Purchase of one (1) Columbus, OH E0271 Mattress, Innerspring new unit 0.0363074414 27 25 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Columbus, OH E0261 Without Mattress new unit 0.0310787430 54 26 $1,267.80

Purchase of one (1) Columbus, OH E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 46 19 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Columbus, OH E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 58 30 $2,814.20

Purchase of one (1) Columbus, OH E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 33 15 $1,087.60

Purchase of one (1) Columbus, OH E0272 Mattress, Foam Rubber new unit 0.0062995907 5 5 $176.47

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Columbus, OH E0912 Standing, Complete With Grab Bar new unit 0.0058651362 19 7 $1,059.80

Purchase of one (1) Columbus, OH E0310 Bed Side Rails, Full Length new unit 0.0057622390 3 4 $154.78

Purchase of one (1) Columbus, OH E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 2 1 $1,196.60

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Columbus, OH E0295 Mattress new unit 0.0034603922 2 1 $1,178.90

Purchase of one (1) Columbus, OH E0305 Bed Side Rails, Half Length new unit 0.0025114521 2 1 $156.40

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Columbus, OH E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 8 4 $2,506.30

Purchase of one (1) Columbus, OH E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 9 4 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Columbus, OH E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 5 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Columbus, OH E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Columbus, OH E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Columbus, OH E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $657.70

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Columbus, OH E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Columbus, OH E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Columbus, OH E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Columbus, OH E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $665.20

Purchase of one (1) Columbus, OH E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,837.50

Purchase of one (1) Columbus, OH E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Columbus, OH E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Dayton, OH E0260 Mattress new unit 0.7844724426 1,195 549 $1,300.40

Purchase of one (1) Dayton, OH E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 89 44 $179.00

Purchase of one (1) Dayton, OH E0271 Mattress, Innerspring new unit 0.0363074414 9 8 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Dayton, OH E0261 Without Mattress new unit 0.0310787430 50 24 $1,267.80

Purchase of one (1) Dayton, OH E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 18 5 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Dayton, OH E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 32 16 $2,814.20

Purchase of one (1) Dayton, OH E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 22 9 $1,087.60

Purchase of one (1) Dayton, OH E0272 Mattress, Foam Rubber new unit 0.0062995907 2 2 $176.47

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Dayton, OH E0912 Standing, Complete With Grab Bar new unit 0.0058651362 17 7 $1,059.80

Purchase of one (1) Dayton, OH E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $154.78

Purchase of one (1) Dayton, OH E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 31 16 $1,196.60

Page 22: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Dayton, OH E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Dayton, OH E0305 Bed Side Rails, Half Length new unit 0.0025114521 3 1 $156.40

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Dayton, OH E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 3 1 $2,506.30

Purchase of one (1) Dayton, OH E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Dayton, OH E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Dayton, OH E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Dayton, OH E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Dayton, OH E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $657.70

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Dayton, OH E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Dayton, OH E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Dayton, OH E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 2 1 $588.10

Purchase of one (1) Dayton, OH E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $665.20

Purchase of one (1) Dayton, OH E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,837.50

Purchase of one (1) Dayton, OH E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Dayton, OH E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0260 Mattress new unit 0.7844724426 767 348 $1,300.40

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 60 28 $185.10

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0271 Mattress, Innerspring new unit 0.0363074414 4 3 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0261 Without Mattress new unit 0.0310787430 53 22 $1,077.60

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 24 11 $285.30

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 5 2 $2,736.10

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,039.50

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $176.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0912 Standing, Complete With Grab Bar new unit 0.0058651362 3 1 $1,059.80

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $170.25

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0295 Mattress new unit 0.0034603922 4 2 $1,002.10

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0305 Bed Side Rails, Half Length new unit 0.0025114521 3 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 3 1 $2,428.00

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0280 Bed Cradle, Any Type new unit 0.0005144856 2 2 $34.26

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $730.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $731.90

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Page 23: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $623.20

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Denver-Aurora-Broomfield, CO E0260 Mattress new unit 0.7844724426 842 393 $1,300.40

Purchase of one (1) Denver-Aurora-Broomfield, CO E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 32 16 $183.40

Purchase of one (1) Denver-Aurora-Broomfield, CO E0271 Mattress, Innerspring new unit 0.0363074414 8 8 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Denver-Aurora-Broomfield, CO E0261 Without Mattress new unit 0.0310787430 66 31 $1,267.80

Purchase of one (1) Denver-Aurora-Broomfield, CO E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 21 8 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Denver-Aurora-Broomfield, CO E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 9 5 $2,814.20

Purchase of one (1) Denver-Aurora-Broomfield, CO E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 3 1 $1,087.60

Purchase of one (1) Denver-Aurora-Broomfield, CO E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $182.28

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Denver-Aurora-Broomfield, CO E0912 Standing, Complete With Grab Bar new unit 0.0058651362 6 2 $1,059.80

Purchase of one (1) Denver-Aurora-Broomfield, CO E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 1 $152.77

Purchase of one (1) Denver-Aurora-Broomfield, CO E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 12 6 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Denver-Aurora-Broomfield, CO E0295 Mattress new unit 0.0034603922 6 3 $1,178.90

Purchase of one (1) Denver-Aurora-Broomfield, CO E0305 Bed Side Rails, Half Length new unit 0.0025114521 5 2 $157.80

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Denver-Aurora-Broomfield, CO E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 7 2 $2,506.30

Purchase of one (1) Denver-Aurora-Broomfield, CO E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 3 1 $890.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Denver-Aurora-Broomfield, CO E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Denver-Aurora-Broomfield, CO E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Denver-Aurora-Broomfield, CO E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Denver-Aurora-Broomfield, CO E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Denver-Aurora-Broomfield, CO E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Denver-Aurora-Broomfield, CO E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Denver-Aurora-Broomfield, CO E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Denver-Aurora-Broomfield, CO E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $664.10

Purchase of one (1) Denver-Aurora-Broomfield, CO E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,843.30

Purchase of one (1) Denver-Aurora-Broomfield, CO E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Denver-Aurora-Broomfield, CO E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Detroit-Warren-Livonia, MI E0260 Mattress new unit 0.7844724426 9,588 4,684 $1,300.40

Purchase of one (1) Detroit-Warren-Livonia, MI E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 700 363 $171.90

Purchase of one (1) Detroit-Warren-Livonia, MI E0271 Mattress, Innerspring new unit 0.0363074414 206 199 $175.69

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Detroit-Warren-Livonia, MI E0261 Without Mattress new unit 0.0310787430 397 196 $1,267.80

Purchase of one (1) Detroit-Warren-Livonia, MI E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 91 47 $303.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Detroit-Warren-Livonia, MI E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 264 151 $2,696.80

Purchase of one (1) Detroit-Warren-Livonia, MI E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 103 45 $1,087.60

Purchase of one (1) Detroit-Warren-Livonia, MI E0272 Mattress, Foam Rubber new unit 0.0062995907 93 90 $185.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Detroit-Warren-Livonia, MI E0912 Standing, Complete With Grab Bar new unit 0.0058651362 68 38 $1,059.80

Page 24: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Detroit-Warren-Livonia, MI E0310 Bed Side Rails, Full Length new unit 0.0057622390 51 50 $179.73

Purchase of one (1) Detroit-Warren-Livonia, MI E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 278 130 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Detroit-Warren-Livonia, MI E0295 Mattress new unit 0.0034603922 52 20 $1,178.90

Purchase of one (1) Detroit-Warren-Livonia, MI E0305 Bed Side Rails, Half Length new unit 0.0025114521 39 22 $142.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Detroit-Warren-Livonia, MI E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 28 16 $2,389.10

Purchase of one (1) Detroit-Warren-Livonia, MI E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 21 8 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Detroit-Warren-Livonia, MI E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 10 6 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Detroit-Warren-Livonia, MI E0911 To Bed, With Grab Bar new unit 0.0007012249 6 4 $461.40

Purchase of one (1) Detroit-Warren-Livonia, MI E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Detroit-Warren-Livonia, MI E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Detroit-Warren-Livonia, MI E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Detroit-Warren-Livonia, MI E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Detroit-Warren-Livonia, MI E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $689.80

Purchase of one (1) Detroit-Warren-Livonia, MI E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Detroit-Warren-Livonia, MI E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,811.80

Purchase of one (1) Detroit-Warren-Livonia, MI E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $655.40

Purchase of one (1) Detroit-Warren-Livonia, MI E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 4 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) El Paso, TX E0260 Mattress new unit 0.7844724426 1,472 754 $1,300.40

Purchase of one (1) El Paso, TX E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 124 60 $185.10

Purchase of one (1) El Paso, TX E0271 Mattress, Innerspring new unit 0.0363074414 55 42 $190.59

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) El Paso, TX E0261 Without Mattress new unit 0.0310787430 20 9 $1,267.80

Purchase of one (1) El Paso, TX E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 38 23 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) El Paso, TX E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 13 6 $2,814.20

Purchase of one (1) El Paso, TX E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 7 4 $1,087.60

Purchase of one (1) El Paso, TX E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $171.28

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) El Paso, TX E0912 Standing, Complete With Grab Bar new unit 0.0058651362 2 1 $1,059.80

Purchase of one (1) El Paso, TX E0310 Bed Side Rails, Full Length new unit 0.0057622390 4 1 $168.88

Purchase of one (1) El Paso, TX E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 2 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) El Paso, TX E0295 Mattress new unit 0.0034603922 19 6 $1,178.90

Purchase of one (1) El Paso, TX E0305 Bed Side Rails, Half Length new unit 0.0025114521 15 5 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) El Paso, TX E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,506.30

Purchase of one (1) El Paso, TX E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) El Paso, TX E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) El Paso, TX E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) El Paso, TX E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) El Paso, TX E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) El Paso, TX E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) El Paso, TX E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Page 25: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) El Paso, TX E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) El Paso, TX E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) El Paso, TX E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,786.50

Purchase of one (1) El Paso, TX E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) El Paso, TX E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Flint, MI E0260 Mattress new unit 0.7844724426 957 468 $1,300.40

Purchase of one (1) Flint, MI E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 79 43 $171.90

Purchase of one (1) Flint, MI E0271 Mattress, Innerspring new unit 0.0363074414 10 9 $175.69

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Flint, MI E0261 Without Mattress new unit 0.0310787430 88 39 $1,267.80

Purchase of one (1) Flint, MI E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 22 10 $303.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Flint, MI E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 25 13 $2,696.80

Purchase of one (1) Flint, MI E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 3 1 $1,087.60

Purchase of one (1) Flint, MI E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $185.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Flint, MI E0912 Standing, Complete With Grab Bar new unit 0.0058651362 15 6 $1,059.80

Purchase of one (1) Flint, MI E0310 Bed Side Rails, Full Length new unit 0.0057622390 5 5 $179.73

Purchase of one (1) Flint, MI E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 45 22 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Flint, MI E0295 Mattress new unit 0.0034603922 22 10 $1,178.90

Purchase of one (1) Flint, MI E0305 Bed Side Rails, Half Length new unit 0.0025114521 9 3 $142.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Flint, MI E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 9 4 $2,389.10

Purchase of one (1) Flint, MI E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Flint, MI E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Flint, MI E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Flint, MI E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Flint, MI E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Flint, MI E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Flint, MI E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Flint, MI E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $689.80

Purchase of one (1) Flint, MI E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Flint, MI E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,811.80

Purchase of one (1) Flint, MI E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $655.40

Purchase of one (1) Flint, MI E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Fresno, CA E0260 Mattress new unit 0.7844724426 1,828 942 $1,300.40

Purchase of one (1) Fresno, CA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 227 117 $163.20

Purchase of one (1) Fresno, CA E0271 Mattress, Innerspring new unit 0.0363074414 14 8 $176.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Fresno, CA E0261 Without Mattress new unit 0.0310787430 48 18 $1,178.30

Purchase of one (1) Fresno, CA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 30 14 $313.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Fresno, CA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 21 8 $2,686.40

Purchase of one (1) Fresno, CA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $955.30

Page 26: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Fresno, CA E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Fresno, CA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 9 4 $1,059.80

Purchase of one (1) Fresno, CA E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $176.32

Purchase of one (1) Fresno, CA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,150.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Fresno, CA E0295 Mattress new unit 0.0034603922 3 2 $1,178.90

Purchase of one (1) Fresno, CA E0305 Bed Side Rails, Half Length new unit 0.0025114521 3 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Fresno, CA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 2 1 $2,378.60

Purchase of one (1) Fresno, CA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $837.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Fresno, CA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Fresno, CA E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) Fresno, CA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Fresno, CA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Fresno, CA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Fresno, CA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Fresno, CA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Fresno, CA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Fresno, CA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,881.00

Purchase of one (1) Fresno, CA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Fresno, CA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Grand Rapids-Wyoming, MI E0260 Mattress new unit 0.7844724426 1,127 547 $1,300.40

Purchase of one (1) Grand Rapids-Wyoming, MI E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 102 51 $171.90

Purchase of one (1) Grand Rapids-Wyoming, MI E0271 Mattress, Innerspring new unit 0.0363074414 17 17 $175.69

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Grand Rapids-Wyoming, MI E0261 Without Mattress new unit 0.0310787430 39 15 $1,267.80

Purchase of one (1) Grand Rapids-Wyoming, MI E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 16 10 $303.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Grand Rapids-Wyoming, MI E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 34 21 $2,696.80

Purchase of one (1) Grand Rapids-Wyoming, MI E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 48 22 $1,087.60

Purchase of one (1) Grand Rapids-Wyoming, MI E0272 Mattress, Foam Rubber new unit 0.0062995907 4 4 $185.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Grand Rapids-Wyoming, MI E0912 Standing, Complete With Grab Bar new unit 0.0058651362 27 16 $1,059.80

Purchase of one (1) Grand Rapids-Wyoming, MI E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 2 $179.73

Purchase of one (1) Grand Rapids-Wyoming, MI E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 5 2 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Grand Rapids-Wyoming, MI E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Grand Rapids-Wyoming, MI E0305 Bed Side Rails, Half Length new unit 0.0025114521 6 3 $142.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Grand Rapids-Wyoming, MI E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,389.10

Purchase of one (1) Grand Rapids-Wyoming, MI E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 30 15 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Grand Rapids-Wyoming, MI E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Grand Rapids-Wyoming, MI E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Grand Rapids-Wyoming, MI E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Grand Rapids-Wyoming, MI E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Page 27: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Grand Rapids-Wyoming, MI E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Grand Rapids-Wyoming, MI E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Grand Rapids-Wyoming, MI E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $689.80

Purchase of one (1) Grand Rapids-Wyoming, MI E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Grand Rapids-Wyoming, MI E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,811.80

Purchase of one (1) Grand Rapids-Wyoming, MI E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $655.40

Purchase of one (1) Grand Rapids-Wyoming, MI E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Greensboro-High Point, NC E0260 Mattress new unit 0.7844724426 984 474 $1,300.40

Purchase of one (1) Greensboro-High Point, NC E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 103 49 $157.30

Purchase of one (1) Greensboro-High Point, NC E0271 Mattress, Innerspring new unit 0.0363074414 25 24 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Greensboro-High Point, NC E0261 Without Mattress new unit 0.0310787430 32 16 $1,077.60

Purchase of one (1) Greensboro-High Point, NC E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 17 9 $273.60

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Greensboro-High Point, NC E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 16 9 $2,814.20

Purchase of one (1) Greensboro-High Point, NC E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $975.70

Purchase of one (1) Greensboro-High Point, NC E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Greensboro-High Point, NC E0912 Standing, Complete With Grab Bar new unit 0.0058651362 10 5 $1,059.80

Purchase of one (1) Greensboro-High Point, NC E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $164.67

Purchase of one (1) Greensboro-High Point, NC E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Greensboro-High Point, NC E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Greensboro-High Point, NC E0305 Bed Side Rails, Half Length new unit 0.0025114521 15 6 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Greensboro-High Point, NC E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,506.30

Purchase of one (1) Greensboro-High Point, NC E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $845.20

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Greensboro-High Point, NC E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Greensboro-High Point, NC E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Greensboro-High Point, NC E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Greensboro-High Point, NC E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $736.70

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Greensboro-High Point, NC E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Greensboro-High Point, NC E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Greensboro-High Point, NC E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $609.20

Purchase of one (1) Greensboro-High Point, NC E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Greensboro-High Point, NC E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Greensboro-High Point, NC E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Greensboro-High Point, NC E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $451.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Greenville-Mauldin-Easley, SC E0260 Mattress new unit 0.7844724426 1,010 452 $1,300.40

Purchase of one (1) Greenville-Mauldin-Easley, SC E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 115 49 $185.10

Purchase of one (1) Greenville-Mauldin-Easley, SC E0271 Mattress, Innerspring new unit 0.0363074414 31 31 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Greenville-Mauldin-Easley, SC E0261 Without Mattress new unit 0.0310787430 23 10 $1,077.60

Purchase of one (1) Greenville-Mauldin-Easley, SC E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 31 16 $273.60

Page 28: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Greenville-Mauldin-Easley, SC E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 25 12 $2,715.40

Purchase of one (1) Greenville-Mauldin-Easley, SC E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 2 1 $924.50

Purchase of one (1) Greenville-Mauldin-Easley, SC E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Greenville-Mauldin-Easley, SC E0912 Standing, Complete With Grab Bar new unit 0.0058651362 13 6 $1,059.80

Purchase of one (1) Greenville-Mauldin-Easley, SC E0310 Bed Side Rails, Full Length new unit 0.0057622390 4 5 $179.73

Purchase of one (1) Greenville-Mauldin-Easley, SC E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 3 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Greenville-Mauldin-Easley, SC E0295 Mattress new unit 0.0034603922 5 2 $1,002.10

Purchase of one (1) Greenville-Mauldin-Easley, SC E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Greenville-Mauldin-Easley, SC E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 4 2 $2,407.70

Purchase of one (1) Greenville-Mauldin-Easley, SC E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $789.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Greenville-Mauldin-Easley, SC E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Greenville-Mauldin-Easley, SC E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Greenville-Mauldin-Easley, SC E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Greenville-Mauldin-Easley, SC E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Greenville-Mauldin-Easley, SC E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Greenville-Mauldin-Easley, SC E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Greenville-Mauldin-Easley, SC E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $603.30

Purchase of one (1) Greenville-Mauldin-Easley, SC E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $582.90

Purchase of one (1) Greenville-Mauldin-Easley, SC E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Greenville-Mauldin-Easley, SC E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Greenville-Mauldin-Easley, SC E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0260 Mattress new unit 0.7844724426 1,678 808 $1,300.30

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 80 37 $185.10

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0271 Mattress, Innerspring new unit 0.0363074414 19 19 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0261 Without Mattress new unit 0.0310787430 128 56 $1,267.80

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 25 13 $318.30

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 28 15 $2,814.20

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 42 22 $1,087.60

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0912 Standing, Complete With Grab Bar new unit 0.0058651362 6 2 $1,059.80

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0310 Bed Side Rails, Full Length new unit 0.0057622390 9 6 $179.73

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0295 Mattress new unit 0.0034603922 2 1 $1,011.00

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0305 Bed Side Rails, Half Length new unit 0.0025114521 3 2 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 4 1 $2,506.30

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 4 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Page 29: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Honolulu, HI E0260 Mattress new unit 0.7844724426 1,091 561 $1,300.40

Purchase of one (1) Honolulu, HI E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 51 30 $176.20

Purchase of one (1) Honolulu, HI E0271 Mattress, Innerspring new unit 0.0363074414 5 5 $190.92

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Honolulu, HI E0261 Without Mattress new unit 0.0310787430 58 25 $1,272.50

Purchase of one (1) Honolulu, HI E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 13 5 $338.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Honolulu, HI E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 10 5 $2,653.80

Purchase of one (1) Honolulu, HI E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 3 2 $1,031.60

Purchase of one (1) Honolulu, HI E0272 Mattress, Foam Rubber new unit 0.0062995907 4 3 $210.14

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Honolulu, HI E0912 Standing, Complete With Grab Bar new unit 0.0058651362 1 1 $1,059.80

Purchase of one (1) Honolulu, HI E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $190.43

Purchase of one (1) Honolulu, HI E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,242.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Honolulu, HI E0295 Mattress new unit 0.0034603922 1 1 $1,279.00

Purchase of one (1) Honolulu, HI E0305 Bed Side Rails, Half Length new unit 0.0025114521 2 1 $194.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Honolulu, HI E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,346.00

Purchase of one (1) Honolulu, HI E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 3 1 $904.70

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Honolulu, HI E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Honolulu, HI E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Honolulu, HI E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $40.99

Purchase of one (1) Honolulu, HI E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $681.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Honolulu, HI E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Honolulu, HI E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $703.30

Purchase of one (1) Honolulu, HI E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $513.80

Purchase of one (1) Honolulu, HI E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $784.10

Purchase of one (1) Honolulu, HI E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,763.30

Purchase of one (1) Honolulu, HI E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $529.10

Purchase of one (1) Honolulu, HI E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $414.60

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Houston-Sugar Land-Baytown, TX E0260 Mattress new unit 0.7844724426 6,581 3,154 $1,300.40

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 765 383 $185.10

Page 30: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0271 Mattress, Innerspring new unit 0.0363074414 168 162 $190.59

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Houston-Sugar Land-Baytown, TX E0261 Without Mattress new unit 0.0310787430 309 148 $1,267.80

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 130 57 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Houston-Sugar Land-Baytown, TX E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 127 68 $2,814.20

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 29 12 $1,087.60

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0272 Mattress, Foam Rubber new unit 0.0062995907 25 24 $171.28

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Houston-Sugar Land-Baytown, TX E0912 Standing, Complete With Grab Bar new unit 0.0058651362 55 28 $1,059.80

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0310 Bed Side Rails, Full Length new unit 0.0057622390 21 17 $168.88

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 63 34 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Houston-Sugar Land-Baytown, TX E0295 Mattress new unit 0.0034603922 11 4 $1,178.90

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0305 Bed Side Rails, Half Length new unit 0.0025114521 8 4 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Houston-Sugar Land-Baytown, TX E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 36 19 $2,506.30

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 13 4 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Houston-Sugar Land-Baytown, TX E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 17 6 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Houston-Sugar Land-Baytown, TX E0911 To Bed, With Grab Bar new unit 0.0007012249 3 1 $461.40

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Houston-Sugar Land-Baytown, TX E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 2 1 $6,623.40

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,786.50

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Huntington-Ashland, WV-KY-OH E0260 Mattress new unit 0.7844724426 883 434 $1,300.40

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 139 65 $179.00

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0271 Mattress, Innerspring new unit 0.0363074414 43 43 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Huntington-Ashland, WV-KY-OH E0261 Without Mattress new unit 0.0310787430 4 1 $1,267.80

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 14 6 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Huntington-Ashland, WV-KY-OH E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 29 16 $2,814.20

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,087.60

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $176.47

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Huntington-Ashland, WV-KY-OH E0912 Standing, Complete With Grab Bar new unit 0.0058651362 15 9 $1,059.80

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $154.78

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,196.60

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Huntington-Ashland, WV-KY-OH E0295 Mattress new unit 0.0034603922 2 1 $1,178.90

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $156.40

Page 31: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Huntington-Ashland, WV-KY-OH E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,506.30

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Huntington-Ashland, WV-KY-OH E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Huntington-Ashland, WV-KY-OH E0911 To Bed, With Grab Bar new unit 0.0007012249 5 3 $461.40

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $657.70

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Huntington-Ashland, WV-KY-OH E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $665.20

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,837.50

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Indiana-Chicago Metro CBA E0260 Mattress new unit 0.7844724426 1,415 676 $1,300.40

Purchase of one (1) Indiana-Chicago Metro CBA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 147 71 $185.10

Purchase of one (1) Indiana-Chicago Metro CBA E0271 Mattress, Innerspring new unit 0.0363074414 15 13 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Indiana-Chicago Metro CBA E0261 Without Mattress new unit 0.0310787430 65 29 $1,173.80

Purchase of one (1) Indiana-Chicago Metro CBA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 9 4 $283.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Indiana-Chicago Metro CBA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 28 16 $2,814.20

Purchase of one (1) Indiana-Chicago Metro CBA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 7 1 $969.10

Purchase of one (1) Indiana-Chicago Metro CBA E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $174.58

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Indiana-Chicago Metro CBA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 10 4 $1,059.80

Purchase of one (1) Indiana-Chicago Metro CBA E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $171.62

Purchase of one (1) Indiana-Chicago Metro CBA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,190.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Indiana-Chicago Metro CBA E0295 Mattress new unit 0.0034603922 1 1 $1,008.10

Purchase of one (1) Indiana-Chicago Metro CBA E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Indiana-Chicago Metro CBA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 9 7 $2,506.30

Purchase of one (1) Indiana-Chicago Metro CBA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Indiana-Chicago Metro CBA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Indiana-Chicago Metro CBA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Indiana-Chicago Metro CBA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Indiana-Chicago Metro CBA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $759.70

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Indiana-Chicago Metro CBA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Indiana-Chicago Metro CBA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Indiana-Chicago Metro CBA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Indiana-Chicago Metro CBA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Indiana-Chicago Metro CBA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Indiana-Chicago Metro CBA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $595.40

Page 32: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Indiana-Chicago Metro CBA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Indianapolis-Carmel, IN E0260 Mattress new unit 0.7844724426 1,980 920 $1,300.40

Purchase of one (1) Indianapolis-Carmel, IN E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 113 53 $185.10

Purchase of one (1) Indianapolis-Carmel, IN E0271 Mattress, Innerspring new unit 0.0363074414 29 29 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Indianapolis-Carmel, IN E0261 Without Mattress new unit 0.0310787430 84 36 $1,173.80

Purchase of one (1) Indianapolis-Carmel, IN E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 110 56 $283.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Indianapolis-Carmel, IN E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 52 31 $2,814.20

Purchase of one (1) Indianapolis-Carmel, IN E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 4 2 $969.10

Purchase of one (1) Indianapolis-Carmel, IN E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $174.58

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Indianapolis-Carmel, IN E0912 Standing, Complete With Grab Bar new unit 0.0058651362 31 18 $1,059.80

Purchase of one (1) Indianapolis-Carmel, IN E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 1 $171.62

Purchase of one (1) Indianapolis-Carmel, IN E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 9 6 $1,190.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Indianapolis-Carmel, IN E0295 Mattress new unit 0.0034603922 3 1 $1,008.10

Purchase of one (1) Indianapolis-Carmel, IN E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Indianapolis-Carmel, IN E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 36 20 $2,506.30

Purchase of one (1) Indianapolis-Carmel, IN E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Indianapolis-Carmel, IN E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 7 3 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Indianapolis-Carmel, IN E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Indianapolis-Carmel, IN E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Indianapolis-Carmel, IN E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $759.70

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Indianapolis-Carmel, IN E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Indianapolis-Carmel, IN E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Indianapolis-Carmel, IN E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Indianapolis-Carmel, IN E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Indianapolis-Carmel, IN E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Indianapolis-Carmel, IN E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $595.40

Purchase of one (1) Indianapolis-Carmel, IN E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Jackson, MS E0260 Mattress new unit 0.7844724426 990 467 $1,300.40

Purchase of one (1) Jackson, MS E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 136 68 $163.40

Purchase of one (1) Jackson, MS E0271 Mattress, Innerspring new unit 0.0363074414 13 13 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Jackson, MS E0261 Without Mattress new unit 0.0310787430 107 51 $1,077.60

Purchase of one (1) Jackson, MS E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 18 6 $273.60

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Jackson, MS E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 31 17 $2,526.80

Purchase of one (1) Jackson, MS E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 6 2 $924.50

Purchase of one (1) Jackson, MS E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Jackson, MS E0912 Standing, Complete With Grab Bar new unit 0.0058651362 7 4 $1,059.80

Purchase of one (1) Jackson, MS E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 2 $162.11

Purchase of one (1) Jackson, MS E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Page 33: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Jackson, MS E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Jackson, MS E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Jackson, MS E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 8 4 $2,219.20

Purchase of one (1) Jackson, MS E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 2 1 $769.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Jackson, MS E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Jackson, MS E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) Jackson, MS E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Jackson, MS E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Jackson, MS E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Jackson, MS E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Jackson, MS E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Jackson, MS E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $680.70

Purchase of one (1) Jackson, MS E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,896.70

Purchase of one (1) Jackson, MS E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $605.70

Purchase of one (1) Jackson, MS E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $484.60

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Jacksonville, FL E0260 Mattress new unit 0.7844724426 2,040 920 $1,300.40

Purchase of one (1) Jacksonville, FL E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 223 107 $185.10

Purchase of one (1) Jacksonville, FL E0271 Mattress, Innerspring new unit 0.0363074414 21 21 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Jacksonville, FL E0261 Without Mattress new unit 0.0310787430 62 24 $1,077.60

Purchase of one (1) Jacksonville, FL E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 79 39 $285.30

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Jacksonville, FL E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 61 37 $2,736.10

Purchase of one (1) Jacksonville, FL E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,039.50

Purchase of one (1) Jacksonville, FL E0272 Mattress, Foam Rubber new unit 0.0062995907 5 4 $176.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Jacksonville, FL E0912 Standing, Complete With Grab Bar new unit 0.0058651362 17 8 $1,059.80

Purchase of one (1) Jacksonville, FL E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 1 $170.25

Purchase of one (1) Jacksonville, FL E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Jacksonville, FL E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Jacksonville, FL E0305 Bed Side Rails, Half Length new unit 0.0025114521 2 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Jacksonville, FL E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,428.00

Purchase of one (1) Jacksonville, FL E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Jacksonville, FL E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Jacksonville, FL E0911 To Bed, With Grab Bar new unit 0.0007012249 5 2 $461.40

Purchase of one (1) Jacksonville, FL E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $34.26

Purchase of one (1) Jacksonville, FL E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $730.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Jacksonville, FL E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Jacksonville, FL E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $731.90

Purchase of one (1) Jacksonville, FL E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Jacksonville, FL E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Page 34: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Jacksonville, FL E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Jacksonville, FL E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $623.20

Purchase of one (1) Jacksonville, FL E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Knoxville, TN E0260 Mattress new unit 0.7844724426 1,079 487 $1,300.40

Purchase of one (1) Knoxville, TN E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 75 40 $162.30

Purchase of one (1) Knoxville, TN E0271 Mattress, Innerspring new unit 0.0363074414 18 14 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Knoxville, TN E0261 Without Mattress new unit 0.0310787430 19 6 $1,077.60

Purchase of one (1) Knoxville, TN E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 38 18 $273.60

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Knoxville, TN E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 23 10 $2,588.40

Purchase of one (1) Knoxville, TN E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,012.30

Purchase of one (1) Knoxville, TN E0272 Mattress, Foam Rubber new unit 0.0062995907 2 2 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Knoxville, TN E0912 Standing, Complete With Grab Bar new unit 0.0058651362 11 5 $1,059.80

Purchase of one (1) Knoxville, TN E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $179.73

Purchase of one (1) Knoxville, TN E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Knoxville, TN E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Knoxville, TN E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Knoxville, TN E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 2 1 $2,280.40

Purchase of one (1) Knoxville, TN E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $769.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Knoxville, TN E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Knoxville, TN E0911 To Bed, With Grab Bar new unit 0.0007012249 4 1 $461.40

Purchase of one (1) Knoxville, TN E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Knoxville, TN E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Knoxville, TN E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Knoxville, TN E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Knoxville, TN E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Knoxville, TN E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $593.10

Purchase of one (1) Knoxville, TN E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,893.00

Purchase of one (1) Knoxville, TN E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Knoxville, TN E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Lakeland-Winter Haven, FL E0260 Mattress new unit 0.7844724426 1,190 567 $1,300.40

Purchase of one (1) Lakeland-Winter Haven, FL E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 88 37 $185.10

Purchase of one (1) Lakeland-Winter Haven, FL E0271 Mattress, Innerspring new unit 0.0363074414 4 4 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Lakeland-Winter Haven, FL E0261 Without Mattress new unit 0.0310787430 13 5 $1,077.60

Purchase of one (1) Lakeland-Winter Haven, FL E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 36 14 $285.30

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Lakeland-Winter Haven, FL E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 36 21 $2,736.10

Purchase of one (1) Lakeland-Winter Haven, FL E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 2 1 $1,039.50

Purchase of one (1) Lakeland-Winter Haven, FL E0272 Mattress, Foam Rubber new unit 0.0062995907 4 4 $176.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Lakeland-Winter Haven, FL E0912 Standing, Complete With Grab Bar new unit 0.0058651362 16 7 $1,059.80

Page 35: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Lakeland-Winter Haven, FL E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $170.25

Purchase of one (1) Lakeland-Winter Haven, FL E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Lakeland-Winter Haven, FL E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Lakeland-Winter Haven, FL E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Lakeland-Winter Haven, FL E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 6 2 $2,428.00

Purchase of one (1) Lakeland-Winter Haven, FL E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Lakeland-Winter Haven, FL E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Lakeland-Winter Haven, FL E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Lakeland-Winter Haven, FL E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $34.26

Purchase of one (1) Lakeland-Winter Haven, FL E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $730.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Lakeland-Winter Haven, FL E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Lakeland-Winter Haven, FL E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $731.90

Purchase of one (1) Lakeland-Winter Haven, FL E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Lakeland-Winter Haven, FL E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Lakeland-Winter Haven, FL E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Lakeland-Winter Haven, FL E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $623.20

Purchase of one (1) Lakeland-Winter Haven, FL E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Las Vegas-Paradise, NV E0260 Mattress new unit 0.7844724426 1,632 770 $1,300.40

Purchase of one (1) Las Vegas-Paradise, NV E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 78 39 $185.10

Purchase of one (1) Las Vegas-Paradise, NV E0271 Mattress, Innerspring new unit 0.0363074414 10 8 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Las Vegas-Paradise, NV E0261 Without Mattress new unit 0.0310787430 76 33 $1,267.80

Purchase of one (1) Las Vegas-Paradise, NV E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 57 30 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Las Vegas-Paradise, NV E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 43 23 $2,680.40

Purchase of one (1) Las Vegas-Paradise, NV E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,087.60

Purchase of one (1) Las Vegas-Paradise, NV E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Las Vegas-Paradise, NV E0912 Standing, Complete With Grab Bar new unit 0.0058651362 3 1 $1,059.80

Purchase of one (1) Las Vegas-Paradise, NV E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 1 $179.73

Purchase of one (1) Las Vegas-Paradise, NV E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 2 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Las Vegas-Paradise, NV E0295 Mattress new unit 0.0034603922 4 2 $1,178.90

Purchase of one (1) Las Vegas-Paradise, NV E0305 Bed Side Rails, Half Length new unit 0.0025114521 3 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Las Vegas-Paradise, NV E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 5 1 $2,372.80

Purchase of one (1) Las Vegas-Paradise, NV E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 3 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Las Vegas-Paradise, NV E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Las Vegas-Paradise, NV E0911 To Bed, With Grab Bar new unit 0.0007012249 3 1 $461.40

Purchase of one (1) Las Vegas-Paradise, NV E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Las Vegas-Paradise, NV E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Las Vegas-Paradise, NV E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Las Vegas-Paradise, NV E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Page 36: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Las Vegas-Paradise, NV E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Las Vegas-Paradise, NV E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Las Vegas-Paradise, NV E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,722.00

Purchase of one (1) Las Vegas-Paradise, NV E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Las Vegas-Paradise, NV E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0260 Mattress new unit 0.7844724426 1,045 471 $1,300.40

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 201 96 $185.10

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0271 Mattress, Innerspring new unit 0.0363074414 9 9 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0261 Without Mattress new unit 0.0310787430 63 31 $1,267.80

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 30 15 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 21 12 $2,814.20

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,087.60

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0272 Mattress, Foam Rubber new unit 0.0062995907 4 4 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0912 Standing, Complete With Grab Bar new unit 0.0058651362 9 4 $1,059.80

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 3 $179.73

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0295 Mattress new unit 0.0034603922 5 1 $1,178.90

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,506.30

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $671.00

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,800.40

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Los Angeles County CBA E0260 Mattress new unit 0.7844724426 12,886 6,416 $1,300.40

Purchase of one (1) Los Angeles County CBA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 1,135 561 $163.20

Purchase of one (1) Los Angeles County CBA E0271 Mattress, Innerspring new unit 0.0363074414 334 286 $176.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Los Angeles County CBA E0261 Without Mattress new unit 0.0310787430 699 348 $1,178.30

Purchase of one (1) Los Angeles County CBA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 230 113 $313.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Los Angeles County CBA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 98 47 $2,686.40

Purchase of one (1) Los Angeles County CBA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 8 3 $955.30

Page 37: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Los Angeles County CBA E0272 Mattress, Foam Rubber new unit 0.0062995907 82 83 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Los Angeles County CBA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 70 30 $1,059.80

Purchase of one (1) Los Angeles County CBA E0310 Bed Side Rails, Full Length new unit 0.0057622390 160 143 $176.32

Purchase of one (1) Los Angeles County CBA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 130 72 $1,150.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Los Angeles County CBA E0295 Mattress new unit 0.0034603922 270 120 $1,178.90

Purchase of one (1) Los Angeles County CBA E0305 Bed Side Rails, Half Length new unit 0.0025114521 168 85 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Los Angeles County CBA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 29 17 $2,378.60

Purchase of one (1) Los Angeles County CBA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 3 1 $837.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Los Angeles County CBA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 5 3 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Los Angeles County CBA E0911 To Bed, With Grab Bar new unit 0.0007012249 9 6 $461.40

Purchase of one (1) Los Angeles County CBA E0280 Bed Cradle, Any Type new unit 0.0005144856 27 25 $35.37

Purchase of one (1) Los Angeles County CBA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Los Angeles County CBA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 4 2 $6,623.40

Purchase of one (1) Los Angeles County CBA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Los Angeles County CBA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Los Angeles County CBA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Los Angeles County CBA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,881.00

Purchase of one (1) Los Angeles County CBA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Los Angeles County CBA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Louisville/Jefferson County, KY-IN E0260 Mattress new unit 0.7844724426 1,949 908 $1,300.40

Purchase of one (1) Louisville/Jefferson County, KY-IN E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 219 99 $185.10

Purchase of one (1) Louisville/Jefferson County, KY-IN E0271 Mattress, Innerspring new unit 0.0363074414 25 22 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Louisville/Jefferson County, KY-IN E0261 Without Mattress new unit 0.0310787430 98 55 $1,173.80

Purchase of one (1) Louisville/Jefferson County, KY-IN E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 67 39 $283.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Louisville/Jefferson County, KY-IN E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 41 20 $2,814.20

Purchase of one (1) Louisville/Jefferson County, KY-IN E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 6 1 $969.10

Purchase of one (1) Louisville/Jefferson County, KY-IN E0272 Mattress, Foam Rubber new unit 0.0062995907 6 5 $174.58

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Louisville/Jefferson County, KY-IN E0912 Standing, Complete With Grab Bar new unit 0.0058651362 34 16 $1,059.80

Purchase of one (1) Louisville/Jefferson County, KY-IN E0310 Bed Side Rails, Full Length new unit 0.0057622390 4 4 $171.62

Purchase of one (1) Louisville/Jefferson County, KY-IN E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,190.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Louisville/Jefferson County, KY-IN E0295 Mattress new unit 0.0034603922 1 1 $1,008.10

Purchase of one (1) Louisville/Jefferson County, KY-IN E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Louisville/Jefferson County, KY-IN E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 4 3 $2,506.30

Purchase of one (1) Louisville/Jefferson County, KY-IN E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Louisville/Jefferson County, KY-IN E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Louisville/Jefferson County, KY-IN E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Louisville/Jefferson County, KY-IN E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Louisville/Jefferson County, KY-IN E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $759.70

Page 38: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Louisville/Jefferson County, KY-IN E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Louisville/Jefferson County, KY-IN E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Louisville/Jefferson County, KY-IN E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Louisville/Jefferson County, KY-IN E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Louisville/Jefferson County, KY-IN E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Louisville/Jefferson County, KY-IN E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $595.40

Purchase of one (1) Louisville/Jefferson County, KY-IN E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) McAllen-Edinburg-Mission, TX E0260 Mattress new unit 0.7844724426 1,980 973 $1,300.40

Purchase of one (1) McAllen-Edinburg-Mission, TX E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 455 213 $185.10

Purchase of one (1) McAllen-Edinburg-Mission, TX E0271 Mattress, Innerspring new unit 0.0363074414 152 149 $190.59

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) McAllen-Edinburg-Mission, TX E0261 Without Mattress new unit 0.0310787430 20 9 $1,267.80

Purchase of one (1) McAllen-Edinburg-Mission, TX E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 49 17 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) McAllen-Edinburg-Mission, TX E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 20 12 $2,814.20

Purchase of one (1) McAllen-Edinburg-Mission, TX E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 23 9 $1,087.60

Purchase of one (1) McAllen-Edinburg-Mission, TX E0272 Mattress, Foam Rubber new unit 0.0062995907 18 18 $171.28

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) McAllen-Edinburg-Mission, TX E0912 Standing, Complete With Grab Bar new unit 0.0058651362 1 1 $1,059.80

Purchase of one (1) McAllen-Edinburg-Mission, TX E0310 Bed Side Rails, Full Length new unit 0.0057622390 10 11 $168.88

Purchase of one (1) McAllen-Edinburg-Mission, TX E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) McAllen-Edinburg-Mission, TX E0295 Mattress new unit 0.0034603922 10 4 $1,178.90

Purchase of one (1) McAllen-Edinburg-Mission, TX E0305 Bed Side Rails, Half Length new unit 0.0025114521 5 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) McAllen-Edinburg-Mission, TX E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 3 1 $2,506.30

Purchase of one (1) McAllen-Edinburg-Mission, TX E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 4 2 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) McAllen-Edinburg-Mission, TX E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) McAllen-Edinburg-Mission, TX E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) McAllen-Edinburg-Mission, TX E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) McAllen-Edinburg-Mission, TX E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) McAllen-Edinburg-Mission, TX E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) McAllen-Edinburg-Mission, TX E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) McAllen-Edinburg-Mission, TX E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) McAllen-Edinburg-Mission, TX E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) McAllen-Edinburg-Mission, TX E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,786.50

Purchase of one (1) McAllen-Edinburg-Mission, TX E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) McAllen-Edinburg-Mission, TX E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Memphis, TN-MS-AR E0260 Mattress new unit 0.7844724426 2,094 977 $1,300.40

Purchase of one (1) Memphis, TN-MS-AR E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 284 137 $162.30

Purchase of one (1) Memphis, TN-MS-AR E0271 Mattress, Innerspring new unit 0.0363074414 15 15 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Memphis, TN-MS-AR E0261 Without Mattress new unit 0.0310787430 263 119 $1,077.60

Purchase of one (1) Memphis, TN-MS-AR E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 46 18 $273.60

Page 39: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Memphis, TN-MS-AR E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 37 23 $2,588.40

Purchase of one (1) Memphis, TN-MS-AR E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 2 1 $1,012.30

Purchase of one (1) Memphis, TN-MS-AR E0272 Mattress, Foam Rubber new unit 0.0062995907 3 3 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Memphis, TN-MS-AR E0912 Standing, Complete With Grab Bar new unit 0.0058651362 22 9 $1,059.80

Purchase of one (1) Memphis, TN-MS-AR E0310 Bed Side Rails, Full Length new unit 0.0057622390 3 5 $179.73

Purchase of one (1) Memphis, TN-MS-AR E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 3 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Memphis, TN-MS-AR E0295 Mattress new unit 0.0034603922 3 2 $1,002.10

Purchase of one (1) Memphis, TN-MS-AR E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Memphis, TN-MS-AR E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 20 12 $2,280.40

Purchase of one (1) Memphis, TN-MS-AR E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $769.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Memphis, TN-MS-AR E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Memphis, TN-MS-AR E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Memphis, TN-MS-AR E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Memphis, TN-MS-AR E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Memphis, TN-MS-AR E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Memphis, TN-MS-AR E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Memphis, TN-MS-AR E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Memphis, TN-MS-AR E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $593.10

Purchase of one (1) Memphis, TN-MS-AR E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,893.00

Purchase of one (1) Memphis, TN-MS-AR E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Memphis, TN-MS-AR E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0260 Mattress new unit 0.7844724426 1,144 528 $1,300.40

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 88 43 $172.40

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0271 Mattress, Innerspring new unit 0.0363074414 15 13 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0261 Without Mattress new unit 0.0310787430 111 56 $1,117.50

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 8 4 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 27 14 $2,814.20

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 26 12 $1,087.60

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0912 Standing, Complete With Grab Bar new unit 0.0058651362 10 7 $1,059.80

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $179.73

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 48 25 $1,112.40

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0295 Mattress new unit 0.0034603922 8 2 $1,002.10

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0305 Bed Side Rails, Half Length new unit 0.0025114521 4 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 3 2 $2,506.30

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 4 1 $855.10

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Page 40: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0911 To Bed, With Grab Bar new unit 0.0007012249 3 1 $461.40

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $741.10

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $736.20

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $646.50

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,892.20

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $604.20

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0260 Mattress new unit 0.7844724426 1,351 636 $1,300.40

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 84 41 $172.40

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0271 Mattress, Innerspring new unit 0.0363074414 9 8 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0261 Without Mattress new unit 0.0310787430 76 36 $1,117.50

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 16 8 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 31 15 $2,814.20

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 51 25 $1,087.60

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0272 Mattress, Foam Rubber new unit 0.0062995907 6 5 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0912 Standing, Complete With Grab Bar new unit 0.0058651362 8 3 $1,059.80

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0310 Bed Side Rails, Full Length new unit 0.0057622390 4 4 $179.73

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 14 6 $1,112.40

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0305 Bed Side Rails, Half Length new unit 0.0025114521 9 5 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,506.30

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 23 12 $855.10

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0280 Bed Cradle, Any Type new unit 0.0005144856 2 2 $35.37

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 11 8 $741.10

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $736.20

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $646.50

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,892.20

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $604.20

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30Nashville-Davidson--Murfreesboro--Franklin, Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) TN E0260 Mattress new unit 0.7844724426 1,861 831 $1,300.40Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 175 81 $162.30

Page 41: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0271 Mattress, Innerspring new unit 0.0363074414 30 27 $205.57Nashville-Davidson--Murfreesboro--Franklin, Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) TN E0261 Without Mattress new unit 0.0310787430 63 32 $1,077.60Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 55 29 $273.60

Nashville-Davidson--Murfreesboro--Franklin, Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) TN E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 31 14 $2,588.40Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,012.30Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35Nashville-Davidson--Murfreesboro--Franklin, Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) TN E0912 Standing, Complete With Grab Bar new unit 0.0058651362 12 5 $1,059.80Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 1 $179.73Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 2 1 $1,028.10Nashville-Davidson--Murfreesboro--Franklin, Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) TN E0295 Mattress new unit 0.0034603922 1 1 $1,002.10Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Nashville-Davidson--Murfreesboro--Franklin, Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) TN E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 8 3 $2,280.40Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $769.30Nashville-Davidson--Murfreesboro--Franklin, Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) TN E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80Nashville-Davidson--Murfreesboro--Franklin, Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) TN E0911 To Bed, With Grab Bar new unit 0.0007012249 5 1 $461.40Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90Nashville-Davidson--Murfreesboro--Franklin, Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) TN E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 2 1 $588.10Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $593.10Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,893.00Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80Nashville-Davidson--Murfreesboro--Franklin, Purchase of one (1) TN E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30Nassau-Brooklyn-Queens-Richmond County Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Metro CBA E0260 Mattress new unit 0.7844724426 10,011 5,201 $1,300.40Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 228 114 $185.10Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0271 Mattress, Innerspring new unit 0.0363074414 185 182 $174.73Nassau-Brooklyn-Queens-Richmond County Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Metro CBA E0261 Without Mattress new unit 0.0310787430 440 212 $1,267.80Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 54 25 $321.90

Nassau-Brooklyn-Queens-Richmond County Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Metro CBA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 74 37 $2,734.30Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 13 6 $1,087.60Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0272 Mattress, Foam Rubber new unit 0.0062995907 4 4 $159.25Nassau-Brooklyn-Queens-Richmond County Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Metro CBA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 12 4 $1,059.80Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0310 Bed Side Rails, Full Length new unit 0.0057622390 50 44 $152.77Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 33 17 $1,209.50Nassau-Brooklyn-Queens-Richmond County Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Metro CBA E0295 Mattress new unit 0.0034603922 10 6 $1,178.90Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0305 Bed Side Rails, Half Length new unit 0.0025114521 10 4 $140.00

Page 42: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Nassau-Brooklyn-Queens-Richmond County Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Metro CBA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 14 8 $2,426.50Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 20 9 $769.30Nassau-Brooklyn-Queens-Richmond County Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Metro CBA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 19 10 $7,134.80Nassau-Brooklyn-Queens-Richmond County Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Metro CBA E0911 To Bed, With Grab Bar new unit 0.0007012249 5 2 $461.40Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 2 1 $771.60Nassau-Brooklyn-Queens-Richmond County Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Metro CBA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $681.70Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $626.00Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) New Haven-Milford, CT E0260 Mattress new unit 0.7844724426 1,285 593 $1,300.30

Purchase of one (1) New Haven-Milford, CT E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 40 20 $185.10

Purchase of one (1) New Haven-Milford, CT E0271 Mattress, Innerspring new unit 0.0363074414 27 27 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) New Haven-Milford, CT E0261 Without Mattress new unit 0.0310787430 132 61 $1,267.80

Purchase of one (1) New Haven-Milford, CT E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 10 6 $318.30

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) New Haven-Milford, CT E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 15 9 $2,814.20

Purchase of one (1) New Haven-Milford, CT E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 6 4 $1,087.60

Purchase of one (1) New Haven-Milford, CT E0272 Mattress, Foam Rubber new unit 0.0062995907 5 5 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) New Haven-Milford, CT E0912 Standing, Complete With Grab Bar new unit 0.0058651362 3 1 $1,059.80

Purchase of one (1) New Haven-Milford, CT E0310 Bed Side Rails, Full Length new unit 0.0057622390 12 7 $179.73

Purchase of one (1) New Haven-Milford, CT E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) New Haven-Milford, CT E0295 Mattress new unit 0.0034603922 1 1 $1,011.00

Purchase of one (1) New Haven-Milford, CT E0305 Bed Side Rails, Half Length new unit 0.0025114521 5 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) New Haven-Milford, CT E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 7 4 $2,506.30

Purchase of one (1) New Haven-Milford, CT E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) New Haven-Milford, CT E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) New Haven-Milford, CT E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) New Haven-Milford, CT E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) New Haven-Milford, CT E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) New Haven-Milford, CT E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) New Haven-Milford, CT E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) New Haven-Milford, CT E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) New Haven-Milford, CT E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) New Haven-Milford, CT E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) New Haven-Milford, CT E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Page 43: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) New Haven-Milford, CT E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) New Orleans-Metairie-Kenner, LA E0260 Mattress new unit 0.7844724426 1,460 685 $1,300.50

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 144 71 $173.70

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0271 Mattress, Innerspring new unit 0.0363074414 11 10 $178.16

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) New Orleans-Metairie-Kenner, LA E0261 Without Mattress new unit 0.0310787430 34 16 $1,267.80

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 43 21 $273.60

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) New Orleans-Metairie-Kenner, LA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 15 7 $2,643.10

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,017.20

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) New Orleans-Metairie-Kenner, LA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 4 1 $1,059.80

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $179.73

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) New Orleans-Metairie-Kenner, LA E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0305 Bed Side Rails, Half Length new unit 0.0025114521 4 2 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) New Orleans-Metairie-Kenner, LA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 3 2 $2,335.10

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $777.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) New Orleans-Metairie-Kenner, LA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) New Orleans-Metairie-Kenner, LA E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) New Orleans-Metairie-Kenner, LA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $640.00

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,803.00

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) North East NY CBA Metro E0260 Mattress new unit 0.7844724426 1,824 879 $1,300.40

Purchase of one (1) North East NY CBA Metro E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 64 35 $185.10

Purchase of one (1) North East NY CBA Metro E0271 Mattress, Innerspring new unit 0.0363074414 31 29 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) North East NY CBA Metro E0261 Without Mattress new unit 0.0310787430 124 63 $1,267.80

Purchase of one (1) North East NY CBA Metro E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 7 2 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) North East NY CBA Metro E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 12 7 $2,734.30

Purchase of one (1) North East NY CBA Metro E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 22 10 $1,087.60

Purchase of one (1) North East NY CBA Metro E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) North East NY CBA Metro E0912 Standing, Complete With Grab Bar new unit 0.0058651362 1 1 $1,059.80

Purchase of one (1) North East NY CBA Metro E0310 Bed Side Rails, Full Length new unit 0.0057622390 14 10 $152.77

Purchase of one (1) North East NY CBA Metro E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Page 44: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) North East NY CBA Metro E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) North East NY CBA Metro E0305 Bed Side Rails, Half Length new unit 0.0025114521 2 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) North East NY CBA Metro E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 4 1 $2,426.50

Purchase of one (1) North East NY CBA Metro E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 2 1 $769.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) North East NY CBA Metro E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) North East NY CBA Metro E0911 To Bed, With Grab Bar new unit 0.0007012249 3 1 $461.40

Purchase of one (1) North East NY CBA Metro E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) North East NY CBA Metro E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) North East NY CBA Metro E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) North East NY CBA Metro E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) North East NY CBA Metro E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $681.70

Purchase of one (1) North East NY CBA Metro E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $626.00

Purchase of one (1) North East NY CBA Metro E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) North East NY CBA Metro E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) North East NY CBA Metro E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) North Port-Bradenton-Sarasota, FL E0260 Mattress new unit 0.7844724426 1,176 504 $1,300.40

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 69 27 $185.10

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0271 Mattress, Innerspring new unit 0.0363074414 2 1 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) North Port-Bradenton-Sarasota, FL E0261 Without Mattress new unit 0.0310787430 34 11 $1,077.60

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 23 6 $285.30

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) North Port-Bradenton-Sarasota, FL E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 12 6 $2,736.10

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 7 2 $1,039.50

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0272 Mattress, Foam Rubber new unit 0.0062995907 2 1 $176.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) North Port-Bradenton-Sarasota, FL E0912 Standing, Complete With Grab Bar new unit 0.0058651362 2 1 $1,059.80

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 1 $170.25

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 12 4 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) North Port-Bradenton-Sarasota, FL E0295 Mattress new unit 0.0034603922 5 2 $1,002.10

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0305 Bed Side Rails, Half Length new unit 0.0025114521 3 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) North Port-Bradenton-Sarasota, FL E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,428.00

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 4 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) North Port-Bradenton-Sarasota, FL E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) North Port-Bradenton-Sarasota, FL E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $34.26

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $730.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) North Port-Bradenton-Sarasota, FL E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $731.90

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Page 45: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $623.20

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Northern NJ Metro CBA E0260 Mattress new unit 0.7844724426 6,497 3,192 $1,300.40

Purchase of one (1) Northern NJ Metro CBA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 165 76 $181.00

Purchase of one (1) Northern NJ Metro CBA E0271 Mattress, Innerspring new unit 0.0363074414 127 124 $195.52

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Northern NJ Metro CBA E0261 Without Mattress new unit 0.0310787430 138 68 $1,077.60

Purchase of one (1) Northern NJ Metro CBA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 32 15 $293.30

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Northern NJ Metro CBA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 48 25 $2,646.20

Purchase of one (1) Northern NJ Metro CBA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 21 6 $940.40

Purchase of one (1) Northern NJ Metro CBA E0272 Mattress, Foam Rubber new unit 0.0062995907 3 3 $180.44

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Northern NJ Metro CBA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 2 1 $1,059.80

Purchase of one (1) Northern NJ Metro CBA E0310 Bed Side Rails, Full Length new unit 0.0057622390 79 106 $179.73

Purchase of one (1) Northern NJ Metro CBA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,032.00

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Northern NJ Metro CBA E0295 Mattress new unit 0.0034603922 52 24 $1,032.00

Purchase of one (1) Northern NJ Metro CBA E0305 Bed Side Rails, Half Length new unit 0.0025114521 13 4 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Northern NJ Metro CBA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 5 2 $2,338.30

Purchase of one (1) Northern NJ Metro CBA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 9 5 $860.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Northern NJ Metro CBA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Northern NJ Metro CBA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Northern NJ Metro CBA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $34.26

Purchase of one (1) Northern NJ Metro CBA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Northern NJ Metro CBA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Northern NJ Metro CBA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Northern NJ Metro CBA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Northern NJ Metro CBA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $626.50

Purchase of one (1) Northern NJ Metro CBA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Northern NJ Metro CBA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $635.90

Purchase of one (1) Northern NJ Metro CBA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Northern-Chicago Metro CBA E0260 Mattress new unit 0.7844724426 1,215 557 $1,300.40

Purchase of one (1) Northern-Chicago Metro CBA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 67 33 $185.10

Purchase of one (1) Northern-Chicago Metro CBA E0271 Mattress, Innerspring new unit 0.0363074414 7 7 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Northern-Chicago Metro CBA E0261 Without Mattress new unit 0.0310787430 58 30 $1,267.80

Purchase of one (1) Northern-Chicago Metro CBA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 24 12 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Northern-Chicago Metro CBA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 11 7 $2,814.20

Purchase of one (1) Northern-Chicago Metro CBA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 21 9 $1,087.60

Purchase of one (1) Northern-Chicago Metro CBA E0272 Mattress, Foam Rubber new unit 0.0062995907 2 2 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Northern-Chicago Metro CBA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 11 5 $1,059.80

Page 46: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Northern-Chicago Metro CBA E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $163.72

Purchase of one (1) Northern-Chicago Metro CBA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 5 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Northern-Chicago Metro CBA E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Northern-Chicago Metro CBA E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Northern-Chicago Metro CBA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 4 1 $2,506.30

Purchase of one (1) Northern-Chicago Metro CBA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Northern-Chicago Metro CBA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Northern-Chicago Metro CBA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Northern-Chicago Metro CBA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Northern-Chicago Metro CBA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 2 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Northern-Chicago Metro CBA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Northern-Chicago Metro CBA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Northern-Chicago Metro CBA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Northern-Chicago Metro CBA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Northern-Chicago Metro CBA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,799.00

Purchase of one (1) Northern-Chicago Metro CBA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Northern-Chicago Metro CBA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $433.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Ocala, FL E0260 Mattress new unit 0.7844724426 602 253 $1,300.40

Purchase of one (1) Ocala, FL E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 79 30 $185.10

Purchase of one (1) Ocala, FL E0271 Mattress, Innerspring new unit 0.0363074414 2 1 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Ocala, FL E0261 Without Mattress new unit 0.0310787430 25 9 $1,077.60

Purchase of one (1) Ocala, FL E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 60 31 $285.30

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Ocala, FL E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 11 3 $2,736.10

Purchase of one (1) Ocala, FL E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 25 8 $1,039.50

Purchase of one (1) Ocala, FL E0272 Mattress, Foam Rubber new unit 0.0062995907 3 3 $176.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Ocala, FL E0912 Standing, Complete With Grab Bar new unit 0.0058651362 3 1 $1,059.80

Purchase of one (1) Ocala, FL E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 1 $170.25

Purchase of one (1) Ocala, FL E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Ocala, FL E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Ocala, FL E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Ocala, FL E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,428.00

Purchase of one (1) Ocala, FL E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 10 5 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Ocala, FL E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Ocala, FL E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Ocala, FL E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $34.26

Purchase of one (1) Ocala, FL E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $730.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Ocala, FL E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Ocala, FL E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $731.90

Page 47: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Ocala, FL E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Ocala, FL E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 2 1 $685.80

Purchase of one (1) Ocala, FL E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Ocala, FL E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $623.20

Purchase of one (1) Ocala, FL E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Oklahoma City, OK E0260 Mattress new unit 0.7844724426 1,522 711 $1,300.40

Purchase of one (1) Oklahoma City, OK E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 362 169 $179.00

Purchase of one (1) Oklahoma City, OK E0271 Mattress, Innerspring new unit 0.0363074414 59 57 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Oklahoma City, OK E0261 Without Mattress new unit 0.0310787430 58 27 $1,267.80

Purchase of one (1) Oklahoma City, OK E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 57 25 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Oklahoma City, OK E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 18 11 $2,814.20

Purchase of one (1) Oklahoma City, OK E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 2 1 $1,087.60

Purchase of one (1) Oklahoma City, OK E0272 Mattress, Foam Rubber new unit 0.0062995907 7 6 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Oklahoma City, OK E0912 Standing, Complete With Grab Bar new unit 0.0058651362 27 11 $1,059.80

Purchase of one (1) Oklahoma City, OK E0310 Bed Side Rails, Full Length new unit 0.0057622390 3 3 $179.73

Purchase of one (1) Oklahoma City, OK E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Oklahoma City, OK E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Oklahoma City, OK E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Oklahoma City, OK E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 8 3 $2,506.30

Purchase of one (1) Oklahoma City, OK E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Oklahoma City, OK E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Oklahoma City, OK E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) Oklahoma City, OK E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Oklahoma City, OK E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Oklahoma City, OK E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Oklahoma City, OK E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Oklahoma City, OK E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Oklahoma City, OK E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $582.90

Purchase of one (1) Oklahoma City, OK E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,869.90

Purchase of one (1) Oklahoma City, OK E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Oklahoma City, OK E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Omaha-Council Bluffs, NE-IA E0260 Mattress new unit 0.7844724426 521 249 $1,300.50

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 43 24 $165.70

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0271 Mattress, Innerspring new unit 0.0363074414 18 17 $187.35

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Omaha-Council Bluffs, NE-IA E0261 Without Mattress new unit 0.0310787430 23 13 $1,267.80

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 24 10 $296.80

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Omaha-Council Bluffs, NE-IA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 16 9 $2,814.20

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 2 1 $1,087.60

Page 48: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0272 Mattress, Foam Rubber new unit 0.0062995907 2 2 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Omaha-Council Bluffs, NE-IA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 8 4 $1,059.80

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $178.35

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Omaha-Council Bluffs, NE-IA E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0305 Bed Side Rails, Half Length new unit 0.0025114521 2 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Omaha-Council Bluffs, NE-IA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 2 1 $2,506.30

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Omaha-Council Bluffs, NE-IA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Omaha-Council Bluffs, NE-IA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Omaha-Council Bluffs, NE-IA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $620.60

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $458.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Orange County CBA E0260 Mattress new unit 0.7844724426 3,416 1,590 $1,300.40

Purchase of one (1) Orange County CBA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 215 99 $163.20

Purchase of one (1) Orange County CBA E0271 Mattress, Innerspring new unit 0.0363074414 48 44 $176.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Orange County CBA E0261 Without Mattress new unit 0.0310787430 113 54 $1,178.30

Purchase of one (1) Orange County CBA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 43 21 $313.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Orange County CBA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 18 8 $2,686.40

Purchase of one (1) Orange County CBA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 8 3 $955.30

Purchase of one (1) Orange County CBA E0272 Mattress, Foam Rubber new unit 0.0062995907 27 27 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Orange County CBA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 3 1 $1,059.80

Purchase of one (1) Orange County CBA E0310 Bed Side Rails, Full Length new unit 0.0057622390 16 14 $176.32

Purchase of one (1) Orange County CBA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 4 1 $1,150.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Orange County CBA E0295 Mattress new unit 0.0034603922 31 16 $1,178.90

Purchase of one (1) Orange County CBA E0305 Bed Side Rails, Half Length new unit 0.0025114521 5 3 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Orange County CBA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 2 1 $2,378.60

Purchase of one (1) Orange County CBA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 13 5 $837.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Orange County CBA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Orange County CBA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Orange County CBA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Orange County CBA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Page 49: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Orange County CBA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Orange County CBA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Orange County CBA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Orange County CBA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Orange County CBA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,881.00

Purchase of one (1) Orange County CBA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Orange County CBA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0260 Mattress new unit 0.7844724426 1,276 592 $1,300.40

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 152 68 $163.20

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0271 Mattress, Innerspring new unit 0.0363074414 4 4 $176.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0261 Without Mattress new unit 0.0310787430 34 14 $1,178.30

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 16 8 $313.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 7 2 $2,686.40

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $955.30

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 1 1 $1,059.80

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0310 Bed Side Rails, Full Length new unit 0.0057622390 3 1 $176.32

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 10 6 $1,150.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0295 Mattress new unit 0.0034603922 7 1 $1,178.90

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0305 Bed Side Rails, Half Length new unit 0.0025114521 16 8 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,378.60

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $837.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0280 Bed Cradle, Any Type new unit 0.0005144856 15 15 $35.37

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,881.00

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0260 Mattress new unit 0.7844724426 810 370 $1,300.40

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 50 22 $185.10

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0271 Mattress, Innerspring new unit 0.0363074414 5 5 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0261 Without Mattress new unit 0.0310787430 69 35 $1,077.60

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 19 11 $285.30

Page 50: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 8 3 $2,736.10

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 5 1 $1,039.50

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0272 Mattress, Foam Rubber new unit 0.0062995907 15 16 $176.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0912 Standing, Complete With Grab Bar new unit 0.0058651362 4 3 $1,059.80

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0310 Bed Side Rails, Full Length new unit 0.0057622390 16 16 $170.25

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0295 Mattress new unit 0.0034603922 17 8 $1,002.10

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,428.00

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $34.26

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 2 1 $730.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $731.90

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $623.20

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70Philadelphia-Camden-Wilmington, PA-NJ-DE- Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) MD E0260 Mattress new unit 0.7844724426 8,315 3,913 $1,300.40Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 368 162 $185.10Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0271 Mattress, Innerspring new unit 0.0363074414 131 124 $197.02Philadelphia-Camden-Wilmington, PA-NJ-DE- Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) MD E0261 Without Mattress new unit 0.0310787430 217 93 $1,191.00Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 77 36 $273.60

Philadelphia-Camden-Wilmington, PA-NJ-DE- Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) MD E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 172 95 $2,702.40Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 41 21 $1,058.80Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0272 Mattress, Foam Rubber new unit 0.0062995907 9 8 $180.44Philadelphia-Camden-Wilmington, PA-NJ-DE- Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) MD E0912 Standing, Complete With Grab Bar new unit 0.0058651362 27 16 $1,059.80Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0310 Bed Side Rails, Full Length new unit 0.0057622390 22 25 $152.77Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 92 39 $1,209.50Philadelphia-Camden-Wilmington, PA-NJ-DE- Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) MD E0295 Mattress new unit 0.0034603922 48 24 $1,178.90Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0305 Bed Side Rails, Half Length new unit 0.0025114521 25 12 $148.20

Philadelphia-Camden-Wilmington, PA-NJ-DE- Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) MD E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 17 9 $2,394.70Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 6 2 $905.00Philadelphia-Camden-Wilmington, PA-NJ-DE- Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) MD E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 4 2 $7,134.80

Page 51: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Philadelphia-Camden-Wilmington, PA-NJ-DE- Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) MD E0911 To Bed, With Grab Bar new unit 0.0007012249 6 1 $461.40Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $34.26Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $722.90Philadelphia-Camden-Wilmington, PA-NJ-DE- Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) MD E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $750.60Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0260 Mattress new unit 0.7844724426 2,234 1,026 $1,300.40

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 130 60 $185.10

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0271 Mattress, Innerspring new unit 0.0363074414 11 8 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0261 Without Mattress new unit 0.0310787430 80 38 $1,267.80

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 55 23 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 40 21 $2,617.10

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 74 37 $1,087.60

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0272 Mattress, Foam Rubber new unit 0.0062995907 2 2 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0912 Standing, Complete With Grab Bar new unit 0.0058651362 7 3 $1,059.80

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0310 Bed Side Rails, Full Length new unit 0.0057622390 4 4 $179.73

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 16 5 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0295 Mattress new unit 0.0034603922 19 8 $1,178.90

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $163.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 3 1 $2,309.20

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 3 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $768.20

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 4 1 $769.40

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,662.60

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $468.00

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0260 Mattress new unit 0.7844724426 1,611 775 $1,300.40

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 203 93 $173.00

Page 52: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0271 Mattress, Innerspring new unit 0.0363074414 3 2 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0261 Without Mattress new unit 0.0310787430 37 18 $1,267.80

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 37 17 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 41 23 $2,814.20

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 25 13 $1,087.60

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0272 Mattress, Foam Rubber new unit 0.0062995907 6 6 $177.55

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 13 6 $1,059.80

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0310 Bed Side Rails, Full Length new unit 0.0057622390 13 7 $179.73

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 34 18 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0295 Mattress new unit 0.0034603922 4 3 $1,125.50

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0305 Bed Side Rails, Half Length new unit 0.0025114521 9 5 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 2 1 $2,506.30

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 8 4 $861.20

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 2 1 $778.00

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $639.80

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,880.10

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $652.40

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0260 Mattress new unit 0.7844724426 772 376 $1,300.40

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 26 10 $185.10

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0271 Mattress, Innerspring new unit 0.0363074414 13 13 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0261 Without Mattress new unit 0.0310787430 4 1 $1,267.80

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 3 1 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 11 5 $2,734.30

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 3 1 $1,087.60

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0912 Standing, Complete With Grab Bar new unit 0.0058651362 1 1 $1,059.80

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 2 $152.77

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0305 Bed Side Rails, Half Length new unit 0.0025114521 2 1 $140.00

Page 53: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,426.50

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $769.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $681.70

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $626.00

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0260 Mattress new unit 0.7844724426 1,859 882 $1,300.40

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 53 27 $185.10

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0271 Mattress, Innerspring new unit 0.0363074414 46 44 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0261 Without Mattress new unit 0.0310787430 47 22 $1,267.80

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 11 4 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 31 13 $2,814.20

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 25 6 $1,087.60

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0272 Mattress, Foam Rubber new unit 0.0062995907 2 2 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 1 1 $1,059.80

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0310 Bed Side Rails, Full Length new unit 0.0057622390 5 3 $171.28

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 9 4 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0305 Bed Side Rails, Half Length new unit 0.0025114521 6 2 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 2 1 $2,506.30

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 6 2 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0280 Bed Cradle, Any Type new unit 0.0005144856 5 4 $33.86

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Page 54: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Raleigh-Cary, NC E0260 Mattress new unit 0.7844724426 1,286 613 $1,300.40

Purchase of one (1) Raleigh-Cary, NC E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 64 30 $157.30

Purchase of one (1) Raleigh-Cary, NC E0271 Mattress, Innerspring new unit 0.0363074414 22 21 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Raleigh-Cary, NC E0261 Without Mattress new unit 0.0310787430 64 27 $1,077.60

Purchase of one (1) Raleigh-Cary, NC E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 36 19 $273.60

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Raleigh-Cary, NC E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 22 11 $2,814.20

Purchase of one (1) Raleigh-Cary, NC E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 3 1 $975.70

Purchase of one (1) Raleigh-Cary, NC E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Raleigh-Cary, NC E0912 Standing, Complete With Grab Bar new unit 0.0058651362 5 2 $1,059.80

Purchase of one (1) Raleigh-Cary, NC E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 1 $164.67

Purchase of one (1) Raleigh-Cary, NC E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Raleigh-Cary, NC E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Raleigh-Cary, NC E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Raleigh-Cary, NC E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 2 1 $2,506.30

Purchase of one (1) Raleigh-Cary, NC E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $845.20

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Raleigh-Cary, NC E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Raleigh-Cary, NC E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) Raleigh-Cary, NC E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Raleigh-Cary, NC E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $736.70

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Raleigh-Cary, NC E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Raleigh-Cary, NC E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Raleigh-Cary, NC E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $609.20

Purchase of one (1) Raleigh-Cary, NC E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Raleigh-Cary, NC E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 2 1 $1,956.00

Purchase of one (1) Raleigh-Cary, NC E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Raleigh-Cary, NC E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $451.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Richmond, VA E0260 Mattress new unit 0.7844724426 2,081 937 $1,300.40

Purchase of one (1) Richmond, VA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 141 66 $185.10

Purchase of one (1) Richmond, VA E0271 Mattress, Innerspring new unit 0.0363074414 39 36 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Richmond, VA E0261 Without Mattress new unit 0.0310787430 106 48 $1,079.80

Purchase of one (1) Richmond, VA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 29 11 $307.50

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Richmond, VA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 19 8 $2,662.30

Purchase of one (1) Richmond, VA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 4 1 $1,087.60

Purchase of one (1) Richmond, VA E0272 Mattress, Foam Rubber new unit 0.0062995907 2 2 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Richmond, VA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 15 9 $1,059.80

Purchase of one (1) Richmond, VA E0310 Bed Side Rails, Full Length new unit 0.0057622390 11 9 $173.93

Purchase of one (1) Richmond, VA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 3 1 $1,123.10

Page 55: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Richmond, VA E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Richmond, VA E0305 Bed Side Rails, Half Length new unit 0.0025114521 16 5 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Richmond, VA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 11 7 $2,354.50

Purchase of one (1) Richmond, VA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $769.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Richmond, VA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Richmond, VA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Richmond, VA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Richmond, VA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Richmond, VA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Richmond, VA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Richmond, VA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Richmond, VA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $583.10

Purchase of one (1) Richmond, VA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,943.70

Purchase of one (1) Richmond, VA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Richmond, VA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Rochester, NY E0260 Mattress new unit 0.7844724426 761 369 $1,300.40

Purchase of one (1) Rochester, NY E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 48 20 $185.10

Purchase of one (1) Rochester, NY E0271 Mattress, Innerspring new unit 0.0363074414 12 10 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Rochester, NY E0261 Without Mattress new unit 0.0310787430 18 9 $1,267.80

Purchase of one (1) Rochester, NY E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 7 3 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Rochester, NY E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 22 14 $2,734.30

Purchase of one (1) Rochester, NY E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 20 13 $1,087.60

Purchase of one (1) Rochester, NY E0272 Mattress, Foam Rubber new unit 0.0062995907 9 9 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Rochester, NY E0912 Standing, Complete With Grab Bar new unit 0.0058651362 2 1 $1,059.80

Purchase of one (1) Rochester, NY E0310 Bed Side Rails, Full Length new unit 0.0057622390 4 3 $152.77

Purchase of one (1) Rochester, NY E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 3 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Rochester, NY E0295 Mattress new unit 0.0034603922 9 4 $1,178.90

Purchase of one (1) Rochester, NY E0305 Bed Side Rails, Half Length new unit 0.0025114521 3 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Rochester, NY E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,426.50

Purchase of one (1) Rochester, NY E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 17 9 $769.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Rochester, NY E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Rochester, NY E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Rochester, NY E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Rochester, NY E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 6 4 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Rochester, NY E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Rochester, NY E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Rochester, NY E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $681.70

Purchase of one (1) Rochester, NY E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $626.00

Page 56: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Rochester, NY E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Rochester, NY E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Rochester, NY E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0260 Mattress new unit 0.7844724426 1,890 878 $1,300.40

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 241 100 $163.20

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0271 Mattress, Innerspring new unit 0.0363074414 18 16 $176.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0261 Without Mattress new unit 0.0310787430 31 16 $1,178.30

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 42 20 $313.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 22 12 $2,686.40

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 169 74 $955.30

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0272 Mattress, Foam Rubber new unit 0.0062995907 4 4 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 23 12 $1,059.80

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0310 Bed Side Rails, Full Length new unit 0.0057622390 4 3 $176.32

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,150.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,378.60

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $837.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,881.00

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Salt Lake City, UT E0260 Mattress new unit 0.7844724426 440 200 $1,300.40

Purchase of one (1) Salt Lake City, UT E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 42 19 $182.70

Purchase of one (1) Salt Lake City, UT E0271 Mattress, Innerspring new unit 0.0363074414 28 13 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Salt Lake City, UT E0261 Without Mattress new unit 0.0310787430 31 12 $1,267.80

Purchase of one (1) Salt Lake City, UT E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 7 3 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Salt Lake City, UT E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 11 6 $2,814.20

Purchase of one (1) Salt Lake City, UT E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 3 1 $956.60

Purchase of one (1) Salt Lake City, UT E0272 Mattress, Foam Rubber new unit 0.0062995907 2 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Salt Lake City, UT E0912 Standing, Complete With Grab Bar new unit 0.0058651362 1 1 $1,059.80

Page 57: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Salt Lake City, UT E0310 Bed Side Rails, Full Length new unit 0.0057622390 13 4 $179.73

Purchase of one (1) Salt Lake City, UT E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 9 2 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Salt Lake City, UT E0295 Mattress new unit 0.0034603922 31 11 $1,178.90

Purchase of one (1) Salt Lake City, UT E0305 Bed Side Rails, Half Length new unit 0.0025114521 11 3 $154.20

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Salt Lake City, UT E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,506.30

Purchase of one (1) Salt Lake City, UT E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Salt Lake City, UT E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Salt Lake City, UT E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Salt Lake City, UT E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Salt Lake City, UT E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Salt Lake City, UT E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Salt Lake City, UT E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Salt Lake City, UT E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Salt Lake City, UT E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Salt Lake City, UT E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Salt Lake City, UT E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $605.20

Purchase of one (1) Salt Lake City, UT E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) San Antonio-New Braunfels, TX E0260 Mattress new unit 0.7844724426 3,209 1,569 $1,300.40

Purchase of one (1) San Antonio-New Braunfels, TX E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 603 305 $185.10

Purchase of one (1) San Antonio-New Braunfels, TX E0271 Mattress, Innerspring new unit 0.0363074414 118 107 $190.59

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) San Antonio-New Braunfels, TX E0261 Without Mattress new unit 0.0310787430 76 33 $1,267.80

Purchase of one (1) San Antonio-New Braunfels, TX E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 70 34 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) San Antonio-New Braunfels, TX E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 64 32 $2,814.20

Purchase of one (1) San Antonio-New Braunfels, TX E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 5 1 $1,087.60

Purchase of one (1) San Antonio-New Braunfels, TX E0272 Mattress, Foam Rubber new unit 0.0062995907 8 8 $171.28

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) San Antonio-New Braunfels, TX E0912 Standing, Complete With Grab Bar new unit 0.0058651362 23 12 $1,059.80

Purchase of one (1) San Antonio-New Braunfels, TX E0310 Bed Side Rails, Full Length new unit 0.0057622390 12 9 $168.88

Purchase of one (1) San Antonio-New Braunfels, TX E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) San Antonio-New Braunfels, TX E0295 Mattress new unit 0.0034603922 18 10 $1,178.90

Purchase of one (1) San Antonio-New Braunfels, TX E0305 Bed Side Rails, Half Length new unit 0.0025114521 4 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) San Antonio-New Braunfels, TX E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 9 4 $2,506.30

Purchase of one (1) San Antonio-New Braunfels, TX E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 2 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) San Antonio-New Braunfels, TX E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) San Antonio-New Braunfels, TX E0911 To Bed, With Grab Bar new unit 0.0007012249 7 4 $461.40

Purchase of one (1) San Antonio-New Braunfels, TX E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) San Antonio-New Braunfels, TX E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) San Antonio-New Braunfels, TX E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) San Antonio-New Braunfels, TX E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Page 58: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) San Antonio-New Braunfels, TX E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) San Antonio-New Braunfels, TX E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) San Antonio-New Braunfels, TX E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,786.50

Purchase of one (1) San Antonio-New Braunfels, TX E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) San Antonio-New Braunfels, TX E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0260 Mattress new unit 0.7844724426 3,112 1,554 $1,300.40

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 198 99 $163.20

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0271 Mattress, Innerspring new unit 0.0363074414 107 107 $176.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0261 Without Mattress new unit 0.0310787430 250 123 $1,178.30

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 114 53 $313.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 28 12 $2,686.40

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 161 61 $955.30

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0272 Mattress, Foam Rubber new unit 0.0062995907 2 2 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 10 4 $1,059.80

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0310 Bed Side Rails, Full Length new unit 0.0057622390 7 5 $176.32

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,150.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0295 Mattress new unit 0.0034603922 7 3 $1,178.90

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0305 Bed Side Rails, Half Length new unit 0.0025114521 4 3 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 6 4 $2,378.60

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 6 2 $837.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 5 2 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0280 Bed Cradle, Any Type new unit 0.0005144856 8 8 $35.37

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 3 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 2 1 $661.30

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,881.00

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) San Francisco-Oakland-Fremont, CA E0260 Mattress new unit 0.7844724426 4,845 2,342 $1,300.40

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 513 246 $163.20

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0271 Mattress, Innerspring new unit 0.0363074414 46 38 $176.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) San Francisco-Oakland-Fremont, CA E0261 Without Mattress new unit 0.0310787430 139 70 $1,178.30

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 55 27 $313.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) San Francisco-Oakland-Fremont, CA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 34 15 $2,686.40

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 146 60 $955.30

Page 59: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0272 Mattress, Foam Rubber new unit 0.0062995907 39 39 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) San Francisco-Oakland-Fremont, CA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 12 6 $1,059.80

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0310 Bed Side Rails, Full Length new unit 0.0057622390 6 4 $176.32

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 4 2 $1,150.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) San Francisco-Oakland-Fremont, CA E0295 Mattress new unit 0.0034603922 135 70 $1,178.90

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0305 Bed Side Rails, Half Length new unit 0.0025114521 59 26 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) San Francisco-Oakland-Fremont, CA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 5 3 $2,378.60

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 45 17 $837.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) San Francisco-Oakland-Fremont, CA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) San Francisco-Oakland-Fremont, CA E0911 To Bed, With Grab Bar new unit 0.0007012249 7 2 $461.40

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0280 Bed Cradle, Any Type new unit 0.0005144856 8 5 $35.37

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) San Francisco-Oakland-Fremont, CA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,881.00

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0260 Mattress new unit 0.7844724426 1,911 952 $1,300.40

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 201 96 $163.20

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0271 Mattress, Innerspring new unit 0.0363074414 4 3 $176.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0261 Without Mattress new unit 0.0310787430 27 8 $1,178.30

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 64 44 $313.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 8 3 $2,686.40

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 4 2 $955.30

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0272 Mattress, Foam Rubber new unit 0.0062995907 11 11 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 1 1 $1,059.80

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $176.32

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,150.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,378.60

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 3 1 $837.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Page 60: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,881.00

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Scranton--Wilkes-Barre, PA E0260 Mattress new unit 0.7844724426 1,541 732 $1,300.40

Purchase of one (1) Scranton--Wilkes-Barre, PA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 41 15 $185.10

Purchase of one (1) Scranton--Wilkes-Barre, PA E0271 Mattress, Innerspring new unit 0.0363074414 31 30 $197.02

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Scranton--Wilkes-Barre, PA E0261 Without Mattress new unit 0.0310787430 38 15 $1,191.00

Purchase of one (1) Scranton--Wilkes-Barre, PA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 13 7 $273.60

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Scranton--Wilkes-Barre, PA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 12 5 $2,702.40

Purchase of one (1) Scranton--Wilkes-Barre, PA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 2 1 $1,058.80

Purchase of one (1) Scranton--Wilkes-Barre, PA E0272 Mattress, Foam Rubber new unit 0.0062995907 3 3 $180.44

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Scranton--Wilkes-Barre, PA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 4 3 $1,059.80

Purchase of one (1) Scranton--Wilkes-Barre, PA E0310 Bed Side Rails, Full Length new unit 0.0057622390 9 8 $152.77

Purchase of one (1) Scranton--Wilkes-Barre, PA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 3 2 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Scranton--Wilkes-Barre, PA E0295 Mattress new unit 0.0034603922 11 2 $1,178.90

Purchase of one (1) Scranton--Wilkes-Barre, PA E0305 Bed Side Rails, Half Length new unit 0.0025114521 3 1 $148.20

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Scranton--Wilkes-Barre, PA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 6 2 $2,394.70

Purchase of one (1) Scranton--Wilkes-Barre, PA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 3 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Scranton--Wilkes-Barre, PA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Scranton--Wilkes-Barre, PA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Scranton--Wilkes-Barre, PA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $34.26

Purchase of one (1) Scranton--Wilkes-Barre, PA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $722.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Scranton--Wilkes-Barre, PA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Scranton--Wilkes-Barre, PA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $750.60

Purchase of one (1) Scranton--Wilkes-Barre, PA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Scranton--Wilkes-Barre, PA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Scranton--Wilkes-Barre, PA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Scranton--Wilkes-Barre, PA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Scranton--Wilkes-Barre, PA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0260 Mattress new unit 0.7844724426 2,940 1,367 $1,300.40

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 215 111 $173.00

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0271 Mattress, Innerspring new unit 0.0363074414 20 17 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0261 Without Mattress new unit 0.0310787430 93 43 $1,267.80

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 125 62 $321.90

Page 61: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 57 30 $2,814.20

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 29 16 $1,087.60

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0272 Mattress, Foam Rubber new unit 0.0062995907 8 8 $177.55

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 23 11 $1,059.80

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 2 $179.73

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 48 26 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0295 Mattress new unit 0.0034603922 35 15 $1,125.50

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0305 Bed Side Rails, Half Length new unit 0.0025114521 11 6 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 11 6 $2,506.30

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 6 3 $861.20

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 2 1 $778.00

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 2 1 $639.80

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,880.10

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $652.40

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) South-West-Chicago-Metro CBA E0260 Mattress new unit 0.7844724426 1,674 756 $1,300.40

Purchase of one (1) South-West-Chicago-Metro CBA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 70 34 $185.10

Purchase of one (1) South-West-Chicago-Metro CBA E0271 Mattress, Innerspring new unit 0.0363074414 14 14 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) South-West-Chicago-Metro CBA E0261 Without Mattress new unit 0.0310787430 69 32 $1,267.80

Purchase of one (1) South-West-Chicago-Metro CBA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 36 20 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) South-West-Chicago-Metro CBA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 30 15 $2,814.20

Purchase of one (1) South-West-Chicago-Metro CBA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 31 13 $1,087.60

Purchase of one (1) South-West-Chicago-Metro CBA E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) South-West-Chicago-Metro CBA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 6 1 $1,059.80

Purchase of one (1) South-West-Chicago-Metro CBA E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $163.72

Purchase of one (1) South-West-Chicago-Metro CBA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) South-West-Chicago-Metro CBA E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) South-West-Chicago-Metro CBA E0305 Bed Side Rails, Half Length new unit 0.0025114521 4 2 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) South-West-Chicago-Metro CBA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 5 1 $2,506.30

Purchase of one (1) South-West-Chicago-Metro CBA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 2 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) South-West-Chicago-Metro CBA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Page 62: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) South-West-Chicago-Metro CBA E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) South-West-Chicago-Metro CBA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) South-West-Chicago-Metro CBA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 2 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) South-West-Chicago-Metro CBA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) South-West-Chicago-Metro CBA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) South-West-Chicago-Metro CBA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) South-West-Chicago-Metro CBA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) South-West-Chicago-Metro CBA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,799.00

Purchase of one (1) South-West-Chicago-Metro CBA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) South-West-Chicago-Metro CBA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $433.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Southern NY Metro CBA E0260 Mattress new unit 0.7844724426 5,124 2,362 $1,300.40

Purchase of one (1) Southern NY Metro CBA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 143 63 $181.00

Purchase of one (1) Southern NY Metro CBA E0271 Mattress, Innerspring new unit 0.0363074414 45 42 $195.52

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Southern NY Metro CBA E0261 Without Mattress new unit 0.0310787430 124 56 $1,077.60

Purchase of one (1) Southern NY Metro CBA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 42 20 $293.30

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Southern NY Metro CBA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 46 19 $2,646.20

Purchase of one (1) Southern NY Metro CBA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 10 4 $940.40

Purchase of one (1) Southern NY Metro CBA E0272 Mattress, Foam Rubber new unit 0.0062995907 3 3 $180.44

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Southern NY Metro CBA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 9 4 $1,059.80

Purchase of one (1) Southern NY Metro CBA E0310 Bed Side Rails, Full Length new unit 0.0057622390 15 14 $179.73

Purchase of one (1) Southern NY Metro CBA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 8 2 $1,032.00

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Southern NY Metro CBA E0295 Mattress new unit 0.0034603922 11 3 $1,032.00

Purchase of one (1) Southern NY Metro CBA E0305 Bed Side Rails, Half Length new unit 0.0025114521 4 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Southern NY Metro CBA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 7 4 $2,338.30

Purchase of one (1) Southern NY Metro CBA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 4 2 $860.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Southern NY Metro CBA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 10 3 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Southern NY Metro CBA E0911 To Bed, With Grab Bar new unit 0.0007012249 3 1 $461.40

Purchase of one (1) Southern NY Metro CBA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $34.26

Purchase of one (1) Southern NY Metro CBA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Southern NY Metro CBA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Southern NY Metro CBA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Southern NY Metro CBA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Southern NY Metro CBA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $626.50

Purchase of one (1) Southern NY Metro CBA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Southern NY Metro CBA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $635.90

Purchase of one (1) Southern NY Metro CBA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Springfield, MA E0260 Mattress new unit 0.7844724426 736 351 $1,300.40

Purchase of one (1) Springfield, MA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 36 16 $185.10

Page 63: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Springfield, MA E0271 Mattress, Innerspring new unit 0.0363074414 8 8 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Springfield, MA E0261 Without Mattress new unit 0.0310787430 21 10 $1,267.80

Purchase of one (1) Springfield, MA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 9 4 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Springfield, MA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 14 8 $2,814.20

Purchase of one (1) Springfield, MA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 17 8 $1,087.60

Purchase of one (1) Springfield, MA E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Springfield, MA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 2 1 $1,059.80

Purchase of one (1) Springfield, MA E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 2 $171.28

Purchase of one (1) Springfield, MA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Springfield, MA E0295 Mattress new unit 0.0034603922 3 1 $1,178.90

Purchase of one (1) Springfield, MA E0305 Bed Side Rails, Half Length new unit 0.0025114521 4 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Springfield, MA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,506.30

Purchase of one (1) Springfield, MA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 4 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Springfield, MA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Springfield, MA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Springfield, MA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $33.86

Purchase of one (1) Springfield, MA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Springfield, MA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Springfield, MA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Springfield, MA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Springfield, MA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Springfield, MA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Springfield, MA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Springfield, MA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) St. Louis, MO-IL E0260 Mattress new unit 0.7844724426 3,083 1,425 $1,300.40

Purchase of one (1) St. Louis, MO-IL E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 269 135 $185.10

Purchase of one (1) St. Louis, MO-IL E0271 Mattress, Innerspring new unit 0.0363074414 61 56 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) St. Louis, MO-IL E0261 Without Mattress new unit 0.0310787430 83 38 $1,267.80

Purchase of one (1) St. Louis, MO-IL E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 46 20 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) St. Louis, MO-IL E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 95 57 $2,814.20

Purchase of one (1) St. Louis, MO-IL E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 64 28 $1,087.60

Purchase of one (1) St. Louis, MO-IL E0272 Mattress, Foam Rubber new unit 0.0062995907 6 5 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) St. Louis, MO-IL E0912 Standing, Complete With Grab Bar new unit 0.0058651362 32 16 $1,059.80

Purchase of one (1) St. Louis, MO-IL E0310 Bed Side Rails, Full Length new unit 0.0057622390 10 9 $163.72

Purchase of one (1) St. Louis, MO-IL E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 2 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) St. Louis, MO-IL E0295 Mattress new unit 0.0034603922 8 3 $1,178.90

Purchase of one (1) St. Louis, MO-IL E0305 Bed Side Rails, Half Length new unit 0.0025114521 5 2 $164.70

Page 64: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) St. Louis, MO-IL E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 9 4 $2,506.30

Purchase of one (1) St. Louis, MO-IL E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) St. Louis, MO-IL E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 5 4 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) St. Louis, MO-IL E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) St. Louis, MO-IL E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) St. Louis, MO-IL E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) St. Louis, MO-IL E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) St. Louis, MO-IL E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) St. Louis, MO-IL E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) St. Louis, MO-IL E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) St. Louis, MO-IL E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,799.00

Purchase of one (1) St. Louis, MO-IL E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) St. Louis, MO-IL E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $433.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Stockton, CA E0260 Mattress new unit 0.7844724426 983 442 $1,300.40

Purchase of one (1) Stockton, CA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 99 42 $163.20

Purchase of one (1) Stockton, CA E0271 Mattress, Innerspring new unit 0.0363074414 6 5 $176.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Stockton, CA E0261 Without Mattress new unit 0.0310787430 13 4 $1,178.30

Purchase of one (1) Stockton, CA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 38 18 $313.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Stockton, CA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 12 5 $2,686.40

Purchase of one (1) Stockton, CA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $955.30

Purchase of one (1) Stockton, CA E0272 Mattress, Foam Rubber new unit 0.0062995907 4 4 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Stockton, CA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 7 3 $1,059.80

Purchase of one (1) Stockton, CA E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $176.32

Purchase of one (1) Stockton, CA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,150.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Stockton, CA E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Stockton, CA E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Stockton, CA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,378.60

Purchase of one (1) Stockton, CA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $837.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Stockton, CA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Stockton, CA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Stockton, CA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Stockton, CA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Stockton, CA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Stockton, CA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Stockton, CA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Stockton, CA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Stockton, CA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,881.00

Purchase of one (1) Stockton, CA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Page 65: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Stockton, CA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Suffolk County CBA E0260 Mattress new unit 0.7844724426 2,061 983 $1,300.40

Purchase of one (1) Suffolk County CBA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 107 53 $185.10

Purchase of one (1) Suffolk County CBA E0271 Mattress, Innerspring new unit 0.0363074414 31 31 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Suffolk County CBA E0261 Without Mattress new unit 0.0310787430 79 44 $1,267.80

Purchase of one (1) Suffolk County CBA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 16 6 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Suffolk County CBA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 22 10 $2,734.30

Purchase of one (1) Suffolk County CBA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 7 2 $1,087.60

Purchase of one (1) Suffolk County CBA E0272 Mattress, Foam Rubber new unit 0.0062995907 4 4 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Suffolk County CBA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 5 1 $1,059.80

Purchase of one (1) Suffolk County CBA E0310 Bed Side Rails, Full Length new unit 0.0057622390 8 6 $152.77

Purchase of one (1) Suffolk County CBA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 5 2 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Suffolk County CBA E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Suffolk County CBA E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Suffolk County CBA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 3 1 $2,426.50

Purchase of one (1) Suffolk County CBA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $769.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Suffolk County CBA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Suffolk County CBA E0911 To Bed, With Grab Bar new unit 0.0007012249 2 1 $461.40

Purchase of one (1) Suffolk County CBA E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Suffolk County CBA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Suffolk County CBA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Suffolk County CBA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Suffolk County CBA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $681.70

Purchase of one (1) Suffolk County CBA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $626.00

Purchase of one (1) Suffolk County CBA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Suffolk County CBA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Suffolk County CBA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Syracuse, NY E0260 Mattress new unit 0.7844724426 855 367 $1,300.40

Purchase of one (1) Syracuse, NY E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 81 42 $185.10

Purchase of one (1) Syracuse, NY E0271 Mattress, Innerspring new unit 0.0363074414 18 16 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Syracuse, NY E0261 Without Mattress new unit 0.0310787430 5 1 $1,267.80

Purchase of one (1) Syracuse, NY E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 19 8 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Syracuse, NY E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 15 8 $2,734.30

Purchase of one (1) Syracuse, NY E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 11 5 $1,087.60

Purchase of one (1) Syracuse, NY E0272 Mattress, Foam Rubber new unit 0.0062995907 3 3 $159.25

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Syracuse, NY E0912 Standing, Complete With Grab Bar new unit 0.0058651362 4 1 $1,059.80

Purchase of one (1) Syracuse, NY E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 1 $152.77

Purchase of one (1) Syracuse, NY E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,209.50

Page 66: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Syracuse, NY E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Syracuse, NY E0305 Bed Side Rails, Half Length new unit 0.0025114521 5 4 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Syracuse, NY E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,426.50

Purchase of one (1) Syracuse, NY E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $769.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Syracuse, NY E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Syracuse, NY E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Syracuse, NY E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Syracuse, NY E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Syracuse, NY E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Syracuse, NY E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Syracuse, NY E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $681.70

Purchase of one (1) Syracuse, NY E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $626.00

Purchase of one (1) Syracuse, NY E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Syracuse, NY E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Syracuse, NY E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0260 Mattress new unit 0.7844724426 4,080 1,888 $1,300.40

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 291 134 $185.10

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0271 Mattress, Innerspring new unit 0.0363074414 27 23 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0261 Without Mattress new unit 0.0310787430 121 52 $1,077.60

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 109 50 $285.30

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 58 26 $2,736.10

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 65 29 $1,039.50

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0272 Mattress, Foam Rubber new unit 0.0062995907 2 1 $176.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0912 Standing, Complete With Grab Bar new unit 0.0058651362 19 8 $1,059.80

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0310 Bed Side Rails, Full Length new unit 0.0057622390 3 1 $170.25

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 3 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0295 Mattress new unit 0.0034603922 6 1 $1,002.10

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0305 Bed Side Rails, Half Length new unit 0.0025114521 6 3 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 19 9 $2,428.00

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 9 3 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $34.26

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 2 1 $730.30

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $731.90

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Page 67: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $623.20

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $502.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Toledo, OH E0260 Mattress new unit 0.7844724426 697 342 $1,300.40

Purchase of one (1) Toledo, OH E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 66 33 $179.00

Purchase of one (1) Toledo, OH E0271 Mattress, Innerspring new unit 0.0363074414 8 7 $174.73

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Toledo, OH E0261 Without Mattress new unit 0.0310787430 15 7 $1,267.80

Purchase of one (1) Toledo, OH E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 22 11 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Toledo, OH E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 18 12 $2,814.20

Purchase of one (1) Toledo, OH E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 17 6 $1,087.60

Purchase of one (1) Toledo, OH E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $176.47

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Toledo, OH E0912 Standing, Complete With Grab Bar new unit 0.0058651362 11 5 $1,059.80

Purchase of one (1) Toledo, OH E0310 Bed Side Rails, Full Length new unit 0.0057622390 2 4 $154.78

Purchase of one (1) Toledo, OH E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 6 2 $1,196.60

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Toledo, OH E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Toledo, OH E0305 Bed Side Rails, Half Length new unit 0.0025114521 6 1 $156.40

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Toledo, OH E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,506.30

Purchase of one (1) Toledo, OH E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 15 8 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Toledo, OH E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 5 2 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Toledo, OH E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Toledo, OH E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Toledo, OH E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $657.70

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Toledo, OH E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Toledo, OH E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Toledo, OH E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Toledo, OH E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $665.20

Purchase of one (1) Toledo, OH E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,837.50

Purchase of one (1) Toledo, OH E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Toledo, OH E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Tucson, AZ E0260 Mattress new unit 0.7844724426 614 263 $1,300.40

Purchase of one (1) Tucson, AZ E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 39 16 $185.10

Purchase of one (1) Tucson, AZ E0271 Mattress, Innerspring new unit 0.0363074414 3 3 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Tucson, AZ E0261 Without Mattress new unit 0.0310787430 16 6 $1,267.80

Purchase of one (1) Tucson, AZ E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 10 5 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Tucson, AZ E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 9 3 $2,617.10

Purchase of one (1) Tucson, AZ E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 8 3 $1,087.60

Purchase of one (1) Tucson, AZ E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Tucson, AZ E0912 Standing, Complete With Grab Bar new unit 0.0058651362 2 1 $1,059.80

Page 68: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Tucson, AZ E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $179.73

Purchase of one (1) Tucson, AZ E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 5 2 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Tucson, AZ E0295 Mattress new unit 0.0034603922 5 1 $1,178.90

Purchase of one (1) Tucson, AZ E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $163.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Tucson, AZ E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,309.20

Purchase of one (1) Tucson, AZ E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Tucson, AZ E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Tucson, AZ E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Tucson, AZ E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Tucson, AZ E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $768.20

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Tucson, AZ E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Tucson, AZ E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $769.40

Purchase of one (1) Tucson, AZ E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Tucson, AZ E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Tucson, AZ E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,662.60

Purchase of one (1) Tucson, AZ E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Tucson, AZ E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $468.00

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Tulsa, OK E0260 Mattress new unit 0.7844724426 1,157 537 $1,300.40

Purchase of one (1) Tulsa, OK E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 134 59 $179.00

Purchase of one (1) Tulsa, OK E0271 Mattress, Innerspring new unit 0.0363074414 43 41 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Tulsa, OK E0261 Without Mattress new unit 0.0310787430 38 18 $1,267.80

Purchase of one (1) Tulsa, OK E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 40 22 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Tulsa, OK E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 44 26 $2,814.20

Purchase of one (1) Tulsa, OK E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,087.60

Purchase of one (1) Tulsa, OK E0272 Mattress, Foam Rubber new unit 0.0062995907 12 11 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Tulsa, OK E0912 Standing, Complete With Grab Bar new unit 0.0058651362 16 7 $1,059.80

Purchase of one (1) Tulsa, OK E0310 Bed Side Rails, Full Length new unit 0.0057622390 5 4 $179.73

Purchase of one (1) Tulsa, OK E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 4 1 $1,209.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Tulsa, OK E0295 Mattress new unit 0.0034603922 1 1 $1,178.90

Purchase of one (1) Tulsa, OK E0305 Bed Side Rails, Half Length new unit 0.0025114521 3 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Tulsa, OK E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 5 4 $2,506.30

Purchase of one (1) Tulsa, OK E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Tulsa, OK E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Tulsa, OK E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Tulsa, OK E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Tulsa, OK E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Tulsa, OK E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Tulsa, OK E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Page 69: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Tulsa, OK E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Tulsa, OK E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $582.90

Purchase of one (1) Tulsa, OK E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,869.90

Purchase of one (1) Tulsa, OK E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10

Purchase of one (1) Tulsa, OK E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0260 Mattress new unit 0.7844724426 3,288 1,483 $1,300.40

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 407 179 $157.30

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0271 Mattress, Innerspring new unit 0.0363074414 78 76 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0261 Without Mattress new unit 0.0310787430 213 108 $1,077.60

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 118 54 $273.60

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 62 30 $2,814.20

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 18 5 $975.70

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0272 Mattress, Foam Rubber new unit 0.0062995907 4 4 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0912 Standing, Complete With Grab Bar new unit 0.0058651362 26 11 $1,059.80

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0310 Bed Side Rails, Full Length new unit 0.0057622390 12 10 $164.67

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 2 1 $1,028.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0295 Mattress new unit 0.0034603922 2 1 $1,002.10

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0305 Bed Side Rails, Half Length new unit 0.0025114521 2 1 $140.00

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 6 3 $2,506.30

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 13 2 $845.20

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 2 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $736.70

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $609.20

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 2 1 $1,956.00

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $451.50

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Visalia-Porterville, CA E0260 Mattress new unit 0.7844724426 773 358 $1,300.40

Purchase of one (1) Visalia-Porterville, CA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 133 58 $163.20

Purchase of one (1) Visalia-Porterville, CA E0271 Mattress, Innerspring new unit 0.0363074414 39 20 $176.80

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Visalia-Porterville, CA E0261 Without Mattress new unit 0.0310787430 10 4 $1,178.30

Purchase of one (1) Visalia-Porterville, CA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 17 9 $313.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Visalia-Porterville, CA E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 6 2 $2,686.40

Purchase of one (1) Visalia-Porterville, CA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $955.30

Page 70: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Purchase of one (1) Visalia-Porterville, CA E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Visalia-Porterville, CA E0912 Standing, Complete With Grab Bar new unit 0.0058651362 1 1 $1,059.80

Purchase of one (1) Visalia-Porterville, CA E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $176.32

Purchase of one (1) Visalia-Porterville, CA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,150.70

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Visalia-Porterville, CA E0295 Mattress new unit 0.0034603922 42 23 $1,178.90

Purchase of one (1) Visalia-Porterville, CA E0305 Bed Side Rails, Half Length new unit 0.0025114521 40 22 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Visalia-Porterville, CA E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 1 1 $2,378.60

Purchase of one (1) Visalia-Porterville, CA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $837.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Visalia-Porterville, CA E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $7,134.80

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Visalia-Porterville, CA E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Visalia-Porterville, CA E0280 Bed Cradle, Any Type new unit 0.0005144856 3 3 $35.37

Purchase of one (1) Visalia-Porterville, CA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Visalia-Porterville, CA E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40

Purchase of one (1) Visalia-Porterville, CA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30

Purchase of one (1) Visalia-Porterville, CA E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10

Purchase of one (1) Visalia-Porterville, CA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $685.80

Purchase of one (1) Visalia-Porterville, CA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,881.00

Purchase of one (1) Visalia-Porterville, CA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $562.80

Purchase of one (1) Visalia-Porterville, CA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30Washington-Arlington-Alexandria, DC-VA-MD- Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) WV E0260 Mattress new unit 0.7844724426 6,194 2,922 $1,300.40Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 264 119 $185.10Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0271 Mattress, Innerspring new unit 0.0363074414 355 347 $205.57Washington-Arlington-Alexandria, DC-VA-MD- Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) WV E0261 Without Mattress new unit 0.0310787430 644 298 $1,079.80Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 74 36 $307.50

Washington-Arlington-Alexandria, DC-VA-MD- Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) WV E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 71 37 $2,662.30Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 145 64 $1,087.60Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0272 Mattress, Foam Rubber new unit 0.0062995907 9 5 $187.35Washington-Arlington-Alexandria, DC-VA-MD- Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) WV E0912 Standing, Complete With Grab Bar new unit 0.0058651362 27 13 $1,059.80Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0310 Bed Side Rails, Full Length new unit 0.0057622390 17 15 $173.93Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 16 8 $1,123.10Washington-Arlington-Alexandria, DC-VA-MD- Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) WV E0295 Mattress new unit 0.0034603922 6 1 $1,002.10Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0305 Bed Side Rails, Half Length new unit 0.0025114521 9 4 $164.70

Washington-Arlington-Alexandria, DC-VA-MD- Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) WV E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 23 9 $2,354.50Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 42 16 $769.30Washington-Arlington-Alexandria, DC-VA-MD- Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) WV E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 10 4 $7,134.80Washington-Arlington-Alexandria, DC-VA-MD- Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) WV E0911 To Bed, With Grab Bar new unit 0.0007012249 3 1 $461.40Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $30.06Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $655.90

Page 71: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

2010 Your Bid Beneficiary 2010 Allowed Your

Weight Bid Limit Your Cost to Amount (To Estimated

(The relative market Count Units (2012 Fee Purchase provide one [1] unit HCPCS Definition of (Number of (Number of units as described in Capacity

CBA Name HCPCS Code Description importance of the item in Schedule: Bid One (1) Unit Code a Bidding Unit the product unique Medicare for the CBA and amount must Definition of a (Number of units you

(Should be less category based on beneficiaries in the HCPCS code paid be at or below Bidding Unit; can furnish in the

than your bid utilization) CBA that received by Medicare in CY this amount) should include cost CBA for one [1]

amount) the product in CY 2010) to buy unit, year) 2010) overhead and profit)

Washington-Arlington-Alexandria, DC-VA-MD- Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) WV E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $6,623.40Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $661.30Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $588.10Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $583.10Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,943.70Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $662.10Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Wichita, KS E0260 Mattress new unit 0.7844724426 413 195 $1,300.40

Purchase of one (1) Wichita, KS E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 31 16 $185.10

Purchase of one (1) Wichita, KS E0271 Mattress, Innerspring new unit 0.0363074414 8 6 $189.69

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Wichita, KS E0261 Without Mattress new unit 0.0310787430 110 48 $1,135.10

Purchase of one (1) Wichita, KS E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 35 10 $321.90

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Wichita, KS E0303 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress new unit 0.0154803009 8 3 $2,814.20

Purchase of one (1) Wichita, KS E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With Mattress new unit 0.0065015739 1 1 $1,072.70

Purchase of one (1) Wichita, KS E0272 Mattress, Foam Rubber new unit 0.0062995907 1 1 $187.35

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Free Purchase of one (1) Wichita, KS E0912 Standing, Complete With Grab Bar new unit 0.0058651362 16 7 $1,059.80

Purchase of one (1) Wichita, KS E0310 Bed Side Rails, Full Length new unit 0.0057622390 1 1 $179.73

Purchase of one (1) Wichita, KS E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With Mattress new unit 0.0036395094 1 1 $1,123.10

Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Purchase of one (1) Wichita, KS E0295 Mattress new unit 0.0034603922 1 1 $1,002.10

Purchase of one (1) Wichita, KS E0305 Bed Side Rails, Half Length new unit 0.0025114521 1 1 $164.70

Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Purchase of one (1) Wichita, KS E0301 Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0022599258 9 4 $2,506.30

Purchase of one (1) Wichita, KS E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With Mattress new unit 0.0022332487 1 1 $905.00

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Wichita, KS E0304 Pounds, With Any Type Side Rails, With Mattress new unit 0.0008155550 1 1 $6,064.60

Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, Attached Purchase of one (1) Wichita, KS E0911 To Bed, With Grab Bar new unit 0.0007012249 1 1 $461.40

Purchase of one (1) Wichita, KS E0280 Bed Cradle, Any Type new unit 0.0005144856 1 1 $35.37

Purchase of one (1) Wichita, KS E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without Mattress new unit 0.0001714952 1 1 $771.60

Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600 Purchase of one (1) Wichita, KS E0302 Pounds, With Any Type Side Rails, Without Mattress new unit 0.0000952751 1 1 $5,629.90

Purchase of one (1) Wichita, KS E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With Mattress new unit 0.0000685981 1 1 $778.00

Purchase of one (1) Wichita, KS E0290 Hospital Bed, Fixed Height, Without Side Rails, With Mattress new unit 0.0000647871 1 1 $691.90

Purchase of one (1) Wichita, KS E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without Mattress new unit 0.0000419211 1 1 $607.70

Purchase of one (1) Wichita, KS E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any Type new unit 0.0000266770 1 1 $1,956.00

Purchase of one (1) Wichita, KS E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without Mattress new unit 0.0000228660 1 1 $640.30

Purchase of one (1) Wichita, KS E0291 Hospital Bed, Fixed Height, Without Side Rails, Without Mattress new unit 0.0000038110 1 1 $427.30

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Purchase of one (1) Worcester, MA E0260 Mattress new unit 0.7844724426 713 330 $1,300.40

Purchase of one (1) Worcester, MA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab Bar new unit 0.0719174689 21 10 $185.10

Purchase of one (1) Worcester, MA E0271 Mattress, Innerspring new unit 0.0363074414 10 9 $205.57

Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Purchase of one (1) Worcester, MA E0261 Without Mattress new unit 0.0310787430 28 16 $1,267.80

Purchase of one (1) Worcester, MA E0940 Trapeze Bar, Free Standing, Complete With Grab Bar new unit 0.0196838391 5 2 $321.90

Page 72: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

CBA Name HCPCSCode HCPCS Code Description Definition of

a Bidding Unit

Weight (The relative market

importance of the item in the product

category based on utilization)

2010 Beneficiary Count

(Number ofunique Medicare

beneficiaries in theCBA that receivedthe product in CY

2010)

2010 Allowed Units

(Number of unitsfor the CBA and

HCPCS code paidby Medicare in CY

2010)

Bid Limit (2012 Fee

Schedule: Bidamount must

be at or belowthis amount)

Your Cost to Purchase One (1) Unit

(Should be less than your bid

amount)

Your Bid Amount

(To provide one [1] unit as described in

Definition of a Bidding Unit;

should include cost to buy unit,

overhead and profit)

Your Estimated Capacity (Number of

units you can furnish in the

CBA for one [1]year)

Worcester, MA E0303Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0154803009 7 2 $2,814.20

Worcester, MA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0065015739 10 5 $1,087.60

Worcester, MA E0272 Mattress, Foam RubberPurchase of one (1)

new unit 0.0062995907 1 1 $187.35

Worcester, MA E0912Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, FreeStanding, Complete With Grab Bar

Purchase of one (1) new unit 0.0058651362 1 1 $1,059.80

Worcester, MA E0310 Bed Side Rails, Full LengthPurchase of one (1)

new unit 0.0057622390 3 2 $171.28

Worcester, MA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With MattressPurchase of one (1)

new unit 0.0036395094 2 1 $1,209.50

Worcester, MA E0295Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Mattress

Purchase of one (1) new unit 0.0034603922 1 1 $1,178.90

Worcester, MA E0305 Bed Side Rails, Half LengthPurchase of one (1)

new unit 0.0025114521 4 2 $164.70

Worcester, MA E0301Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0022599258 3 1 $2,506.30

Worcester, MA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0022332487 1 1 $905.00

Worcester, MA E0304Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0008155550 1 1 $7,134.80

Worcester, MA E0911Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, AttachedTo Bed, With Grab Bar

Purchase of one (1) new unit 0.0007012249 1 1 $461.40

Worcester, MA E0280 Bed Cradle, Any TypePurchase of one (1)

new unit 0.0005144856 1 1 $33.86

Worcester, MA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0001714952 1 1 $771.60

Worcester, MA E0302Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0000952751 1 1 $6,623.40

Worcester, MA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000685981 1 1 $778.00

Worcester, MA E0290 Hospital Bed, Fixed Height, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000647871 1 1 $691.90

Worcester, MA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0000419211 1 1 $685.80

Worcester, MA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any TypePurchase of one (1)

new unit 0.0000266770 1 1 $1,956.00

Worcester, MA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000228660 1 1 $662.10

Worcester, MA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000038110 1 1 $502.70

Youngstown-Warren-Boardman, OH-PA E0260Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.7844724426 1,059 472 $1,300.40

Youngstown-Warren-Boardman, OH-PA E0910 Trapeze Bars, A/K/A Patient Helper, Attached To Bed, With Grab BarPurchase of one (1)

new unit 0.0719174689 78 37 $179.00

Youngstown-Warren-Boardman, OH-PA E0271 Mattress, InnerspringPurchase of one (1)

new unit 0.0363074414 15 15 $174.73

Youngstown-Warren-Boardman, OH-PA E0261Hospital Bed, Semi-Electric (Head And Foot Adjustment), With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0310787430 10 5 $1,267.80

Youngstown-Warren-Boardman, OH-PA E0940 Trapeze Bar, Free Standing, Complete With Grab BarPurchase of one (1)

new unit 0.0196838391 22 8 $321.90

Youngstown-Warren-Boardman, OH-PA E0303Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0154803009 22 13 $2,814.20

Youngstown-Warren-Boardman, OH-PA E0255 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0065015739 4 1 $1,087.60

Youngstown-Warren-Boardman, OH-PA E0272 Mattress, Foam RubberPurchase of one (1)

new unit 0.0062995907 2 2 $176.47

Youngstown-Warren-Boardman, OH-PA E0912Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, FreeStanding, Complete With Grab Bar

Purchase of one (1) new unit 0.0058651362 7 3 $1,059.80

Youngstown-Warren-Boardman, OH-PA E0310 Bed Side Rails, Full LengthPurchase of one (1)

new unit 0.0057622390 1 1 $154.78

Youngstown-Warren-Boardman, OH-PA E0294 Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, With MattressPurchase of one (1)

new unit 0.0036395094 1 1 $1,196.60

Youngstown-Warren-Boardman, OH-PA E0295Hospital Bed, Semi-Electric (Head And Foot Adjustment), Without Side Rails, Without Mattress

Purchase of one (1) new unit 0.0034603922 1 1 $1,178.90

Youngstown-Warren-Boardman, OH-PA E0305 Bed Side Rails, Half LengthPurchase of one (1)

new unit 0.0025114521 1 1 $156.40

Youngstown-Warren-Boardman, OH-PA E0301Hospital Bed, Heavy Duty, Extra Wide, With Weight Capacity Greater Than 350 Pounds, But Less Than Or Equal To 600 Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0022599258 1 1 $2,506.30

Youngstown-Warren-Boardman, OH-PA E0250 Hospital Bed, Fixed Height, With Any Type Side Rails, With MattressPurchase of one (1)

new unit 0.0022332487 3 1 $905.00

Youngstown-Warren-Boardman, OH-PA E0304Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600Pounds, With Any Type Side Rails, With Mattress

Purchase of one (1) new unit 0.0008155550 1 1 $7,134.80

Page 73: DMEPOS Competitive Bidding Program Bid Preparation ......DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2

CBA Name HCPCSCode HCPCS Code Description Definition of

a Bidding Unit

Weight (The relative market

importance of the item in the product

category based on utilization)

2010 Beneficiary Count

(Number ofunique Medicare

beneficiaries in theCBA that receivedthe product in CY

2010)

2010 Allowed Units

(Number of unitsfor the CBA and

HCPCS code paidby Medicare in CY

2010)

Bid Limit (2012 Fee

Schedule: Bidamount must

be at or belowthis amount)

Your Cost to Purchase One (1) Unit

(Should be less than your bid

amount)

Your Bid Amount

(To provide one [1] unit as described in

Definition of a Bidding Unit;

should include cost to buy unit,

overhead and profit)

Your Estimated Capacity (Number of

units you can furnish in the

CBA for one [1]year)

Youngstown-Warren-Boardman, OH-PA E0911Trapeze Bar, Heavy Duty, For Patient Weight Capacity Greater Than 250 Pounds, AttachedTo Bed, With Grab Bar

Purchase of one (1) new unit 0.0007012249 1 1 $461.40

Youngstown-Warren-Boardman, OH-PA E0280 Bed Cradle, Any TypePurchase of one (1)

new unit 0.0005144856 1 1 $30.06

Youngstown-Warren-Boardman, OH-PA E0256 Hospital Bed, Variable Height, Hi-Lo, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0001714952 1 1 $657.70

Youngstown-Warren-Boardman, OH-PA E0302Hospital Bed, Extra Heavy Duty, Extra Wide, With Weight Capacity Greater Than 600Pounds, With Any Type Side Rails, Without Mattress

Purchase of one (1) new unit 0.0000952751 1 1 $6,623.40

Youngstown-Warren-Boardman, OH-PA E0292 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000685981 1 1 $661.30

Youngstown-Warren-Boardman, OH-PA E0290 Hospital Bed, Fixed Height, Without Side Rails, With MattressPurchase of one (1)

new unit 0.0000647871 1 1 $588.10

Youngstown-Warren-Boardman, OH-PA E0251 Hospital Bed, Fixed Height, With Any Type Side Rails, Without MattressPurchase of one (1)

new unit 0.0000419211 1 1 $665.20

Youngstown-Warren-Boardman, OH-PA E0316 Safety Enclosure Frame/Canopy For Use With Hospital Bed, Any TypePurchase of one (1)

new unit 0.0000266770 1 1 $1,837.50

Youngstown-Warren-Boardman, OH-PA E0293 Hospital Bed, Variable Height, Hi-Lo, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000228660 1 1 $562.80

Youngstown-Warren-Boardman, OH-PA E0291 Hospital Bed, Fixed Height, Without Side Rails, Without MattressPurchase of one (1)

new unit 0.0000038110 1 1 $427.30