DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed...

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DMEPOS Competitive Bidding Program Bid Preparation Worksheet – Round 2 Estimated Capacity & Bid Amount Calculations Support Surfaces (Group 2 Mattresses and Overlays) ***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 4 Albuquerque, NM 4 Allentown-Bethlehem-Easton, PA-NJ 4 Asheville, NC 4 Atlanta-Sandy Springs-Marietta, GA 5 Augusta-Richmond County, GA-SC 5 Austin-Round Rock-San Marcos, TX 5 Bakersfield-Delano, CA 5 Baltimore-Towson, MD 5 Baton Rouge, LA 5 Beaumont-Port Arthur, TX 5 Birmingham-Hoover, AL 5 Boise City-Nampa, ID 6 Boston-Cambridge-Quincy, MA-NH 6 Bridgeport-Stamford-Norwalk, CT 6 Bronx-Manhattan NY CBA 6 Buffalo-Niagara Falls, NY 6 Cape Coral-Fort Myers, FL 6 Central-Chicago Metro CBA 6 Charleston-North Charleston-Summerville, SC 6 Chattanooga, TN-GA 7 Colorado Springs, CO 7 Columbia, SC 7 Columbus, OH 7 Dayton, OH 7 Deltona-Daytona Beach-Ormond Beach, FL 7 Denver-Aurora-Broomfield, CO 7 Detroit-Warren-Livonia, MI 7

Transcript of DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed...

Page 1: DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10 Purchase of one (1)

DMEPOS Competitive Bidding Program

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

Support Surfaces (Group 2 Mattresses and Overlays)

***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 4

Albuquerque, NM 4

Allentown-Bethlehem-Easton, PA-NJ 4

Asheville, NC 4

Atlanta-Sandy Springs-Marietta, GA 5

Augusta-Richmond County, GA-SC 5

Austin-Round Rock-San Marcos, TX 5

Bakersfield-Delano, CA 5

Baltimore-Towson, MD 5

Baton Rouge, LA 5

Beaumont-Port Arthur, TX 5

Birmingham-Hoover, AL 5

Boise City-Nampa, ID 6

Boston-Cambridge-Quincy, MA-NH 6

Bridgeport-Stamford-Norwalk, CT 6

Bronx-Manhattan NY CBA 6

Buffalo-Niagara Falls, NY 6

Cape Coral-Fort Myers, FL 6

Central-Chicago Metro CBA 6

Charleston-North Charleston-Summerville, SC 6

Chattanooga, TN-GA 7

Colorado Springs, CO 7

Columbia, SC 7

Columbus, OH 7

Dayton, OH 7

Deltona-Daytona Beach-Ormond Beach, FL 7

Denver-Aurora-Broomfield, CO 7

Detroit-Warren-Livonia, MI 7

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El Paso, TX 8

Flint, MI 8

Fresno, CA 8

Grand Rapids-Wyoming, MI 8

Greensboro-High Point, NC 8

Greenville-Mauldin-Easley, SC 8

Hartford-West Hartford-East Hartford, CT 8

Honolulu, HI 8

Houston-Sugar Land-Baytown, TX 9

Huntington-Ashland, WV-KY-OH 9

Indiana-Chicago Metro CBA 9

Indianapolis-Carmel, IN 9

Jackson, MS 9

Jacksonville, FL 9

Knoxville, TN 9

Lakeland-Winter Haven, FL 9

Las Vegas-Paradise, NV 9

Little Rock-North Little Rock-Conway, AR 10

Los Angeles County CBA 10

Louisville/Jefferson County, KY-IN 10

McAllen-Edinburg-Mission, TX 10

Memphis, TN-MS-AR 10

Milwaukee-Waukesha-West Allis, WI 10

Minneapolis-St. Paul-Bloomington, MN-WI 10

Nashville-Davidson--Murfreesboro--Franklin, TN 10

Nassau-Brooklyn-Queens-Richmond County Metro CBA 11

New Haven-Milford, CT 11

New Orleans-Metairie-Kenner, LA 11

North East NY CBA Metro 11

Northern-Chicago Metro CBA 11

Northern NJ Metro CBA 11

North Port-Bradenton-Sarasota, FL 11

Ocala, FL 11

Oklahoma City, OK 12

Omaha-Council Bluffs, NE-IA 12

Orange County CBA 12

Oxnard-Thousand Oaks-Ventura, CA 12

Palm Bay-Melbourne-Titusville, FL 12

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Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 12

Phoenix-Mesa-Glendale, AZ 12

Portland-Vancouver-Hillsboro, OR-WA 12

Poughkeepsie-Newburgh-Middletown, NY 13

Providence-New Bedford-Fall River, RI-MA 13

Raleigh-Cary, NC 13

Richmond, VA 13

Rochester, NY 13

Sacramento--Arden-Arcade--Roseville, CA 13

Salt Lake City, UT 13

San Antonio-New Braunfels, TX 13

San Diego-Carlsbad-San Marcos, CA 14

San Francisco-Oakland-Fremont, CA 14

San Jose-Sunnyvale-Santa Clara, CA 14

Scranton--Wilkes-Barre, PA 14

Seattle-Tacoma-Bellevue, WA 14

South-West-Chicago-Metro CBA 14

Southern NY Metro CBA 14

Springfield, MA 14

St. Louis, MO-IL 14

Stockton, CA 15

Suffolk County CBA 15

Syracuse, NY 15

Tampa-St. Petersburg-Clearwater, FL 15

Toledo, OH 15

Tucson, AZ 15

Tulsa, OK 15

Virginia Beach-Norfolk-Newport News, VA-NC 15

Visalia-Porterville, CA 16

Washington-Arlington-Alexandria, DC-VA-MD-WV 16

Wichita, KS 16

Worcester, MA 16

Youngstown-Warren-Boardman, OH-PA 16

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Reference Data Reference Data for Background for Background Bidder Data

Product Category: Support Surfaces (Group 2 Mattresses and Overlays) (You will enter your estimated capacity and bid amountInformational Informational information in DBidS on Form B)Purposes Only Purposes Only

Your Bid 2010 Beneficiary Your 2010 Allowed Weight Bid Limit Your Cost to AmountCount Estimated (The relative market Units (2012 Fee Purchase (To provide one [1]

(Number ofHCPCS Definition of importance of the item in (Number of units Schedule: Bid unit as described in Capacity CBA Name HCPCS Code Description unique Medicare for the CBA and One (1) Unit

amount must Definition of a (Number ofCode a Bidding Unit the product beneficiaries in the HCPCS code paid (Should be less be at or below Bidding Unit; units you can

category based on CBA that received by Medicare in CY than your bid this amount) should include cost furnish in the

utilization) the product in CY 2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Purchase of one (1) Akron, OH E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 39 18 $6,512.60

Purchase of one (1) Akron, OH E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Akron, OH E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Akron, OH E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Albany-Schenectady-Troy, NY E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 55 27 $6,512.60

Purchase of one (1) Albany-Schenectady-Troy, NY E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,841.80

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Albany-Schenectady-Troy, NY E0371 And Width new unit 0.0112288270 1 1 $3,990.20

Purchase of one (1) Albany-Schenectady-Troy, NY E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,546.40

Purchase of one (1) Albany-Schenectady-Troy, NY E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,293.60

Purchase of one (1) Albuquerque, NM E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 24 8 $6,214.50

Purchase of one (1) Albuquerque, NM E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,413.70

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Albuquerque, NM E0371 And Width new unit 0.0112288270 2 1 $3,637.40

Purchase of one (1) Albuquerque, NM E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,056.20

Purchase of one (1) Albuquerque, NM E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,398.00

Purchase of one (1) Allentown-Bethlehem-Easton, PA-NJ E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 98 42 $5,975.70

Purchase of one (1) Allentown-Bethlehem-Easton, PA-NJ E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 1 $4,785.20

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Allentown-Bethlehem-Easton, PA-NJ E0371 And Width new unit 0.0112288270 1 1 $3,943.40

Purchase of one (1) Allentown-Bethlehem-Easton, PA-NJ E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 2 1 $5,481.50

Purchase of one (1) Allentown-Bethlehem-Easton, PA-NJ E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Asheville, NC E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 57 26 $6,512.60

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 bids * 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.

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Your Bid 2010 Beneficiary Your 2010 Allowed Weight Your Cost to AmountCount Bid Limit Estimated (The relative market Units (To provide one [1]

(Number of (2012 Fee Purchase HCPCS Definition of (Number of units unit as described in Capacity

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

category based on HCPCS code paid Bidding Unit; CBA that received be at or below than your bid furnish in the utilization) by Medicare in CY should include cost the product in CY this amount)

2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Purchase of one (1) Asheville, NC E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Asheville, NC E0371 And Width new unit 0.0112288270 4 2 $4,114.90

Purchase of one (1) Asheville, NC E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Asheville, NC E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Atlanta-Sandy Springs-Marietta, GA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 459 191 $6,512.70

Purchase of one (1) Atlanta-Sandy Springs-Marietta, GA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 5 2 $4,843.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Atlanta-Sandy Springs-Marietta, GA E0371 And Width new unit 0.0112288270 1 1 $3,991.30

Purchase of one (1) Atlanta-Sandy Springs-Marietta, GA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 20 9 $5,547.70

Purchase of one (1) Atlanta-Sandy Springs-Marietta, GA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 2 1 $7,892.70

Purchase of one (1) Augusta-Richmond County, GA-SC E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 121 50 $6,512.70

Purchase of one (1) Augusta-Richmond County, GA-SC E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,843.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Augusta-Richmond County, GA-SC E0371 And Width new unit 0.0112288270 1 1 $3,991.30

Purchase of one (1) Augusta-Richmond County, GA-SC E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,547.70

Purchase of one (1) Augusta-Richmond County, GA-SC E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,892.70

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 108 42 $6,512.60

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 5 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Austin-Round Rock-San Marcos, TX E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Austin-Round Rock-San Marcos, TX E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Bakersfield-Delano, CA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 85 30 $6,513.00

Purchase of one (1) Bakersfield-Delano, CA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 2 1 $4,756.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Bakersfield-Delano, CA E0371 And Width new unit 0.0112288270 1 1 $3,920.00

Purchase of one (1) Bakersfield-Delano, CA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,448.90

Purchase of one (1) Bakersfield-Delano, CA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Baltimore-Towson, MD E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 396 183 $6,512.80

Purchase of one (1) Baltimore-Towson, MD E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 2 $4,709.90

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Baltimore-Towson, MD E0371 And Width new unit 0.0112288270 6 2 $3,881.50

Purchase of one (1) Baltimore-Towson, MD E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,395.30

Purchase of one (1) Baltimore-Towson, MD E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 4 1 $7,963.90

Purchase of one (1) Baton Rouge, LA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 119 58 $6,512.80

Purchase of one (1) Baton Rouge, LA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 2 $4,904.80

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Baton Rouge, LA E0371 And Width new unit 0.0112288270 3 1 $4,042.00

Purchase of one (1) Baton Rouge, LA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,618.60

Purchase of one (1) Baton Rouge, LA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,054.20

Purchase of one (1) Beaumont-Port Arthur, TX E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 62 24 $6,512.60

Purchase of one (1) Beaumont-Port Arthur, TX E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Beaumont-Port Arthur, TX E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Beaumont-Port Arthur, TX E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Beaumont-Port Arthur, TX E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Birmingham-Hoover, AL E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 103 40 $6,512.60

Purchase of one (1) Birmingham-Hoover, AL E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 2 1 $4,889.20

Page 6: DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10 Purchase of one (1)

Your Bid 2010 Beneficiary Your 2010 Allowed Weight Your Cost to AmountCount Bid Limit Estimated (The relative market Units (To provide one [1]

(Number of (2012 Fee Purchase HCPCS Definition of (Number of units unit as described in Capacity

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

category based on HCPCS code paid Bidding Unit; CBA that received be at or below than your bid furnish in the utilization) by Medicare in CY should include cost the product in CY this amount)

2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Birmingham-Hoover, AL E0371 And Width new unit 0.0112288270 2 1 $4,029.20

Purchase of one (1) Birmingham-Hoover, AL E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,600.70

Purchase of one (1) Birmingham-Hoover, AL E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 9 2 $8,364.10

Purchase of one (1) Boise City-Nampa, ID E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 17 9 $6,512.60

Purchase of one (1) Boise City-Nampa, ID E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Boise City-Nampa, ID E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Boise City-Nampa, ID E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Boise City-Nampa, ID E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 298 144 $6,512.60

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 12 5 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Boston-Cambridge-Quincy, MA-NH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 3 1 $8,364.10

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 86 36 $6,512.60

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Bridgeport-Stamford-Norwalk, CT E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,286.40

Purchase of one (1) Bronx-Manhattan NY CBA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 651 290 $6,512.60

Purchase of one (1) Bronx-Manhattan NY CBA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 2 1 $4,841.80

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Bronx-Manhattan NY CBA E0371 And Width new unit 0.0112288270 13 4 $3,990.20

Purchase of one (1) Bronx-Manhattan NY CBA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 11 5 $5,546.40

Purchase of one (1) Bronx-Manhattan NY CBA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,293.60

Purchase of one (1) Buffalo-Niagara Falls, NY E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 53 25 $6,512.60

Purchase of one (1) Buffalo-Niagara Falls, NY E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,841.80

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Buffalo-Niagara Falls, NY E0371 And Width new unit 0.0112288270 1 1 $3,990.20

Purchase of one (1) Buffalo-Niagara Falls, NY E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,546.40

Purchase of one (1) Buffalo-Niagara Falls, NY E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,293.60

Purchase of one (1) Cape Coral-Fort Myers, FL E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 61 20 $6,435.00

Purchase of one (1) Cape Coral-Fort Myers, FL E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 7 2 $4,570.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Cape Coral-Fort Myers, FL E0371 And Width new unit 0.0112288270 1 1 $3,766.70

Purchase of one (1) Cape Coral-Fort Myers, FL E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,235.60

Purchase of one (1) Cape Coral-Fort Myers, FL E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,469.10

Purchase of one (1) Central-Chicago Metro CBA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 1,629 790 $6,512.60

Purchase of one (1) Central-Chicago Metro CBA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Central-Chicago Metro CBA E0371 And Width new unit 0.0112288270 4 2 $4,114.90

Purchase of one (1) Central-Chicago Metro CBA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Central-Chicago Metro CBA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 5 1 $7,973.10

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 76 30 $6,348.70

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 5 2 $4,808.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Charleston-North Charleston-Summerville, SC E0371 And Width new unit 0.0112288270 1 1 $3,962.60

Page 7: DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10 Purchase of one (1)

Your Bid 2010 Beneficiary Your 2010 Allowed Weight Your Cost to AmountCount Bid Limit Estimated (The relative market Units (To provide one [1]

(Number of (2012 Fee Purchase HCPCS Definition of (Number of units unit as described in Capacity

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

category based on HCPCS code paid Bidding Unit; CBA that received be at or below than your bid furnish in the utilization) by Medicare in CY should include cost the product in CY this amount)

2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,507.90

Purchase of one (1) Charleston-North Charleston-Summerville, SC E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,690.60

Purchase of one (1) Chattanooga, TN-GA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 56 20 $6,512.70

Purchase of one (1) Chattanooga, TN-GA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,843.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Chattanooga, TN-GA E0371 And Width new unit 0.0112288270 1 1 $3,991.30

Purchase of one (1) Chattanooga, TN-GA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,547.70

Purchase of one (1) Chattanooga, TN-GA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,892.70

Purchase of one (1) Colorado Springs, CO E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 31 11 $6,512.60

Purchase of one (1) Colorado Springs, CO E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Colorado Springs, CO E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Colorado Springs, CO E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Colorado Springs, CO E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Columbia, SC E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 146 68 $6,348.70

Purchase of one (1) Columbia, SC E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,808.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Columbia, SC E0371 And Width new unit 0.0112288270 1 1 $3,962.60

Purchase of one (1) Columbia, SC E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,507.90

Purchase of one (1) Columbia, SC E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,690.60

Purchase of one (1) Columbus, OH E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 159 84 $6,512.60

Purchase of one (1) Columbus, OH E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Columbus, OH E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Columbus, OH E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Columbus, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Dayton, OH E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 53 25 $6,512.60

Purchase of one (1) Dayton, OH E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 11 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Dayton, OH E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Dayton, OH E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Dayton, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 59 21 $6,435.00

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,570.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0371 And Width new unit 0.0112288270 1 1 $3,766.70

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 2 1 $5,235.60

Purchase of one (1) Deltona-Daytona Beach-Ormond Beach, FL E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,469.10

Purchase of one (1) Denver-Aurora-Broomfield, CO E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 73 27 $6,512.60

Purchase of one (1) Denver-Aurora-Broomfield, CO E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 8 3 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Denver-Aurora-Broomfield, CO E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Denver-Aurora-Broomfield, CO E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Denver-Aurora-Broomfield, CO E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Detroit-Warren-Livonia, MI E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 1,046 516 $5,975.70

Purchase of one (1) Detroit-Warren-Livonia, MI E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 12 5 $4,775.00

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Detroit-Warren-Livonia, MI E0371 And Width new unit 0.0112288270 7 2 $3,935.20

Purchase of one (1) Detroit-Warren-Livonia, MI E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,470.00

Page 8: DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10 Purchase of one (1)

Your Bid 2010 Beneficiary Your 2010 Allowed Weight Your Cost to AmountCount Bid Limit Estimated (The relative market Units (To provide one [1]

(Number of (2012 Fee Purchase HCPCS Definition of (Number of units unit as described in Capacity

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

category based on HCPCS code paid Bidding Unit; CBA that received be at or below than your bid furnish in the utilization) by Medicare in CY should include cost the product in CY this amount)

2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Purchase of one (1) Detroit-Warren-Livonia, MI E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 3 1 $8,364.10

Purchase of one (1) El Paso, TX E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 187 78 $6,512.60

Purchase of one (1) El Paso, TX E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) El Paso, TX E0371 And Width new unit 0.0112288270 4 2 $4,114.90

Purchase of one (1) El Paso, TX E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) El Paso, TX E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 2 1 $8,364.10

Purchase of one (1) Flint, MI E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 96 39 $5,975.70

Purchase of one (1) Flint, MI E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,775.00

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Flint, MI E0371 And Width new unit 0.0112288270 1 1 $3,935.20

Purchase of one (1) Flint, MI E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,470.00

Purchase of one (1) Flint, MI E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Fresno, CA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 107 55 $6,513.00

Purchase of one (1) Fresno, CA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,756.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Fresno, CA E0371 And Width new unit 0.0112288270 1 1 $3,920.00

Purchase of one (1) Fresno, CA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,448.90

Purchase of one (1) Fresno, CA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 2 1 $8,364.10

Purchase of one (1) Grand Rapids-Wyoming, MI E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 65 31 $5,975.70

Purchase of one (1) Grand Rapids-Wyoming, MI E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,775.00

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Grand Rapids-Wyoming, MI E0371 And Width new unit 0.0112288270 1 1 $3,935.20

Purchase of one (1) Grand Rapids-Wyoming, MI E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,470.00

Purchase of one (1) Grand Rapids-Wyoming, MI E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Greensboro-High Point, NC E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 46 15 $6,512.60

Purchase of one (1) Greensboro-High Point, NC E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Greensboro-High Point, NC E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Greensboro-High Point, NC E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Greensboro-High Point, NC E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Greenville-Mauldin-Easley, SC E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 48 22 $6,348.70

Purchase of one (1) Greenville-Mauldin-Easley, SC E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,808.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Greenville-Mauldin-Easley, SC E0371 And Width new unit 0.0112288270 1 1 $3,962.60

Purchase of one (1) Greenville-Mauldin-Easley, SC E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,507.90

Purchase of one (1) Greenville-Mauldin-Easley, SC E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 3 1 $7,690.60

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 120 40 $6,512.60

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 4 2 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0371 And Width new unit 0.0112288270 2 1 $4,114.90

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Hartford-West Hartford-East Hartford, CT E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,286.40

Purchase of one (1) Honolulu, HI E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 36 11 $6,512.90

Purchase of one (1) Honolulu, HI E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 9 2 $5,074.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Honolulu, HI E0371 And Width new unit 0.0112288270 1 1 $4,182.20

Purchase of one (1) Honolulu, HI E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,382.70

Purchase of one (1) Honolulu, HI E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,924.20

Page 9: DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10 Purchase of one (1)

Your Bid 2010 Beneficiary Your 2010 Allowed Weight Your Cost to AmountCount Bid Limit Estimated (The relative market Units (To provide one [1]

(Number of (2012 Fee Purchase HCPCS Definition of (Number of units unit as described in Capacity

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

category based on HCPCS code paid Bidding Unit; CBA that received be at or below than your bid furnish in the utilization) by Medicare in CY should include cost the product in CY this amount)

2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 638 266 $6,512.60

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 8 3 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Houston-Sugar Land-Baytown, TX E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Houston-Sugar Land-Baytown, TX E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 41 17 $6,512.60

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Huntington-Ashland, WV-KY-OH E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Huntington-Ashland, WV-KY-OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Indiana-Chicago Metro CBA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 150 81 $6,512.60

Purchase of one (1) Indiana-Chicago Metro CBA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 2 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Indiana-Chicago Metro CBA E0371 And Width new unit 0.0112288270 3 1 $4,114.90

Purchase of one (1) Indiana-Chicago Metro CBA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Indiana-Chicago Metro CBA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 3 1 $8,364.10

Purchase of one (1) Indianapolis-Carmel, IN E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 143 67 $6,512.60

Purchase of one (1) Indianapolis-Carmel, IN E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Indianapolis-Carmel, IN E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Indianapolis-Carmel, IN E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Indianapolis-Carmel, IN E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Jackson, MS E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 130 54 $6,512.50

Purchase of one (1) Jackson, MS E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,474.40

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Jackson, MS E0371 And Width new unit 0.0112288270 1 1 $3,687.30

Purchase of one (1) Jackson, MS E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,125.20

Purchase of one (1) Jackson, MS E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,109.50

Purchase of one (1) Jacksonville, FL E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 166 71 $6,435.00

Purchase of one (1) Jacksonville, FL E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 2 1 $4,570.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Jacksonville, FL E0371 And Width new unit 0.0112288270 1 1 $3,766.70

Purchase of one (1) Jacksonville, FL E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,235.60

Purchase of one (1) Jacksonville, FL E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,469.10

Purchase of one (1) Knoxville, TN E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 54 24 $6,512.80

Purchase of one (1) Knoxville, TN E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,680.80

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Knoxville, TN E0371 And Width new unit 0.0112288270 1 1 $3,857.30

Purchase of one (1) Knoxville, TN E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,362.10

Purchase of one (1) Knoxville, TN E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,675.00

Purchase of one (1) Lakeland-Winter Haven, FL E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 58 23 $6,435.00

Purchase of one (1) Lakeland-Winter Haven, FL E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,570.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Lakeland-Winter Haven, FL E0371 And Width new unit 0.0112288270 1 1 $3,766.70

Purchase of one (1) Lakeland-Winter Haven, FL E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,235.60

Purchase of one (1) Lakeland-Winter Haven, FL E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 2 1 $7,469.10

Purchase of one (1) Las Vegas-Paradise, NV E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 172 80 $5,975.70

Page 10: DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10 Purchase of one (1)

Your Bid 2010 Beneficiary Your 2010 Allowed Weight Your Cost to AmountCount Bid Limit Estimated (The relative market Units (To provide one [1]

(Number of (2012 Fee Purchase HCPCS Definition of (Number of units unit as described in Capacity

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

category based on HCPCS code paid Bidding Unit; CBA that received be at or below than your bid furnish in the utilization) by Medicare in CY should include cost the product in CY this amount)

2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Purchase of one (1) Las Vegas-Paradise, NV E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,746.00

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Las Vegas-Paradise, NV E0371 And Width new unit 0.0112288270 1 1 $3,911.40

Purchase of one (1) Las Vegas-Paradise, NV E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,436.80

Purchase of one (1) Las Vegas-Paradise, NV E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,040.40

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 93 35 $6,512.90

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0371 And Width new unit 0.0112288270 2 2 $4,114.90

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Little Rock-North Little Rock-Conway, AR E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 2 1 $8,364.10

Purchase of one (1) Los Angeles County CBA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 1,857 869 $6,513.00

Purchase of one (1) Los Angeles County CBA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 58 21 $4,756.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Los Angeles County CBA E0371 And Width new unit 0.0112288270 3 1 $3,920.00

Purchase of one (1) Los Angeles County CBA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 3 1 $5,448.90

Purchase of one (1) Los Angeles County CBA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 6 3 $8,364.10

Purchase of one (1) Louisville/Jefferson County, KY-IN E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 152 58 $6,512.60

Purchase of one (1) Louisville/Jefferson County, KY-IN E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Louisville/Jefferson County, KY-IN E0371 And Width new unit 0.0112288270 5 1 $4,114.90

Purchase of one (1) Louisville/Jefferson County, KY-IN E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Louisville/Jefferson County, KY-IN E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) McAllen-Edinburg-Mission, TX E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 243 113 $6,512.60

Purchase of one (1) McAllen-Edinburg-Mission, TX E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 5 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) McAllen-Edinburg-Mission, TX E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) McAllen-Edinburg-Mission, TX E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) McAllen-Edinburg-Mission, TX E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Memphis, TN-MS-AR E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 264 111 $6,512.80

Purchase of one (1) Memphis, TN-MS-AR E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 2 1 $4,680.80

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Memphis, TN-MS-AR E0371 And Width new unit 0.0112288270 1 1 $3,857.30

Purchase of one (1) Memphis, TN-MS-AR E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 19 13 $5,362.10

Purchase of one (1) Memphis, TN-MS-AR E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,675.00

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 52 21 $6,512.60

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Milwaukee-Waukesha-West Allis, WI E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,297.60

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 105 43 $6,512.60

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Minneapolis-St. Paul-Bloomington, MN-WI E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,297.60

Purchase of one (1) Nashville-Davidson--Murfreesboro--Franklin, TN E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 125 49 $6,512.80

Purchase of one (1) Nashville-Davidson--Murfreesboro--Franklin, TN E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 9 3 $4,680.80

Page 11: DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10 Purchase of one (1)

Your Bid 2010 Beneficiary Your 2010 Allowed Weight Your Cost to AmountCount Bid Limit Estimated (The relative market Units (To provide one [1]

(Number of (2012 Fee Purchase HCPCS Definition of (Number of units unit as described in Capacity

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

category based on HCPCS code paid Bidding Unit; CBA that received be at or below than your bid furnish in the utilization) by Medicare in CY should include cost the product in CY this amount)

2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Nashville-Davidson--Murfreesboro--Franklin, TN E0371 And Width new unit 0.0112288270 1 1 $3,857.30

Purchase of one (1) Nashville-Davidson--Murfreesboro--Franklin, TN E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,362.10

Purchase of one (1) Nashville-Davidson--Murfreesboro--Franklin, TN E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 2 1 $7,675.00Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 1,859 896 $6,512.60Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 17 5 $4,841.80Nassau-Brooklyn-Queens-Richmond County Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Metro CBA E0371 And Width new unit 0.0112288270 16 5 $3,990.20Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 60 22 $5,546.40Nassau-Brooklyn-Queens-Richmond County Purchase of one (1) Metro CBA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 16 6 $8,293.60

Purchase of one (1) New Haven-Milford, CT E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 82 32 $6,512.60

Purchase of one (1) New Haven-Milford, CT E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 4 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) New Haven-Milford, CT E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) New Haven-Milford, CT E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 2 1 $5,688.70

Purchase of one (1) New Haven-Milford, CT E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,286.40

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 147 70 $6,512.80

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 4 2 $4,904.80

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) New Orleans-Metairie-Kenner, LA E0371 And Width new unit 0.0112288270 9 4 $4,042.00

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,618.60

Purchase of one (1) New Orleans-Metairie-Kenner, LA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 5 2 $8,054.20

Purchase of one (1) North East NY CBA Metro E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 218 93 $6,512.60

Purchase of one (1) North East NY CBA Metro E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,841.80

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) North East NY CBA Metro E0371 And Width new unit 0.0112288270 4 1 $3,990.20

Purchase of one (1) North East NY CBA Metro E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 6 2 $5,546.40

Purchase of one (1) North East NY CBA Metro E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,293.60

Purchase of one (1) Northern-Chicago Metro CBA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 144 71 $6,512.60

Purchase of one (1) Northern-Chicago Metro CBA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Northern-Chicago Metro CBA E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Northern-Chicago Metro CBA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Northern-Chicago Metro CBA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,973.10

Purchase of one (1) Northern NJ Metro CBA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 716 320 $5,975.70

Purchase of one (1) Northern NJ Metro CBA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 1 $4,685.30

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Northern NJ Metro CBA E0371 And Width new unit 0.0112288270 7 4 $3,861.40

Purchase of one (1) Northern NJ Metro CBA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,367.30

Purchase of one (1) Northern NJ Metro CBA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,048.90

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 68 19 $6,435.00

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,570.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) North Port-Bradenton-Sarasota, FL E0371 And Width new unit 0.0112288270 1 1 $3,766.70

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,235.60

Purchase of one (1) North Port-Bradenton-Sarasota, FL E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,469.10

Purchase of one (1) Ocala, FL E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 26 10 $6,435.00

Purchase of one (1) Ocala, FL E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,570.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Ocala, FL E0371 And Width new unit 0.0112288270 1 1 $3,766.70

Page 12: DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10 Purchase of one (1)

Your Bid 2010 Beneficiary Your 2010 Allowed Weight Your Cost to AmountCount Bid Limit Estimated (The relative market Units (To provide one [1]

(Number of (2012 Fee Purchase HCPCS Definition of (Number of units unit as described in Capacity

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

category based on HCPCS code paid Bidding Unit; CBA that received be at or below than your bid furnish in the utilization) by Medicare in CY should include cost the product in CY this amount)

2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Purchase of one (1) Ocala, FL E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,235.60

Purchase of one (1) Ocala, FL E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,469.10

Purchase of one (1) Oklahoma City, OK E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 118 49 $6,512.60

Purchase of one (1) Oklahoma City, OK E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 2 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Oklahoma City, OK E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Oklahoma City, OK E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Oklahoma City, OK E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,280.00

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 29 13 $6,512.60

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Omaha-Council Bluffs, NE-IA E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Omaha-Council Bluffs, NE-IA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Orange County CBA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 312 140 $6,513.00

Purchase of one (1) Orange County CBA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 2 1 $4,756.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Orange County CBA E0371 And Width new unit 0.0112288270 1 1 $3,920.00

Purchase of one (1) Orange County CBA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,448.90

Purchase of one (1) Orange County CBA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 139 61 $6,513.00

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,756.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0371 And Width new unit 0.0112288270 1 1 $3,920.00

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,448.90

Purchase of one (1) Oxnard-Thousand Oaks-Ventura, CA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 31 12 $6,435.00

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,570.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0371 And Width new unit 0.0112288270 1 1 $3,766.70

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,235.60

Purchase of one (1) Palm Bay-Melbourne-Titusville, FL E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,469.10Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 649 284 $5,975.70Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 9 3 $4,785.20Philadelphia-Camden-Wilmington, PA-NJ-DE- Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) MD E0371 And Width new unit 0.0112288270 35 8 $3,943.40Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,481.50Philadelphia-Camden-Wilmington, PA-NJ-DE- Purchase of one (1) MD E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 219 93 $5,975.70

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 5 2 $4,634.00

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0371 And Width new unit 0.0112288270 1 1 $3,819.10

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,308.60

Purchase of one (1) Phoenix-Mesa-Glendale, AZ E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 3 1 $7,819.40

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 82 28 $6,513.20

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 11 2 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Page 13: DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10 Purchase of one (1)

Your Bid 2010 Beneficiary Your 2010 Allowed Weight Your Cost to AmountCount Bid Limit Estimated (The relative market Units (To provide one [1]

(Number of (2012 Fee Purchase HCPCS Definition of (Number of units unit as described in Capacity

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

category based on HCPCS code paid Bidding Unit; CBA that received be at or below than your bid furnish in the utilization) by Medicare in CY should include cost the product in CY this amount)

2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Purchase of one (1) Portland-Vancouver-Hillsboro, OR-WA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 47 20 $6,512.60

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 13 6 $4,841.80

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0371 And Width new unit 0.0112288270 1 1 $3,990.20

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,546.40

Purchase of one (1) Poughkeepsie-Newburgh-Middletown, NY E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,293.60

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 69 26 $6,512.60

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 2 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0371 And Width new unit 0.0112288270 2 1 $4,114.90

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Providence-New Bedford-Fall River, RI-MA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Raleigh-Cary, NC E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 85 31 $6,512.60

Purchase of one (1) Raleigh-Cary, NC E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 2 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Raleigh-Cary, NC E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Raleigh-Cary, NC E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Raleigh-Cary, NC E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Richmond, VA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 185 76 $6,512.60

Purchase of one (1) Richmond, VA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 16 4 $4,714.00

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Richmond, VA E0371 And Width new unit 0.0112288270 1 1 $3,885.00

Purchase of one (1) Richmond, VA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,399.90

Purchase of one (1) Richmond, VA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,856.30

Purchase of one (1) Rochester, NY E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 49 23 $6,512.60

Purchase of one (1) Rochester, NY E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,841.80

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Rochester, NY E0371 And Width new unit 0.0112288270 11 4 $3,990.20

Purchase of one (1) Rochester, NY E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 4 1 $5,546.40

Purchase of one (1) Rochester, NY E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,293.60

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 74 35 $6,513.00

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 6 1 $4,756.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0371 And Width new unit 0.0112288270 1 1 $3,920.00

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,448.90

Purchase of one (1) Sacramento--Arden-Arcade--Roseville, CA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Salt Lake City, UT E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 39 18 $6,512.60

Purchase of one (1) Salt Lake City, UT E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Salt Lake City, UT E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Salt Lake City, UT E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Salt Lake City, UT E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) San Antonio-New Braunfels, TX E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 234 93 $6,512.60

Purchase of one (1) San Antonio-New Braunfels, TX E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) San Antonio-New Braunfels, TX E0371 And Width new unit 0.0112288270 2 1 $4,114.90

Purchase of one (1) San Antonio-New Braunfels, TX E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 3 1 $5,688.70

Purchase of one (1) San Antonio-New Braunfels, TX E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Page 14: DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10 Purchase of one (1)

Your Bid 2010 Beneficiary Your 2010 Allowed Weight Your Cost to AmountCount Bid Limit Estimated (The relative market Units (To provide one [1]

(Number of (2012 Fee Purchase HCPCS Definition of (Number of units unit as described in Capacity

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

category based on HCPCS code paid Bidding Unit; CBA that received be at or below than your bid furnish in the utilization) by Medicare in CY should include cost the product in CY this amount)

2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 263 111 $6,513.00

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 5 2 $4,756.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0371 And Width new unit 0.0112288270 1 1 $3,920.00

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,448.90

Purchase of one (1) San Diego-Carlsbad-San Marcos, CA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 317 140 $6,513.00

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 4 1 $4,756.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) San Francisco-Oakland-Fremont, CA E0371 And Width new unit 0.0112288270 1 1 $3,920.00

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,448.90

Purchase of one (1) San Francisco-Oakland-Fremont, CA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 84 39 $6,513.00

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,756.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0371 And Width new unit 0.0112288270 1 1 $3,920.00

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,448.90

Purchase of one (1) San Jose-Sunnyvale-Santa Clara, CA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Scranton--Wilkes-Barre, PA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 63 27 $5,975.70

Purchase of one (1) Scranton--Wilkes-Barre, PA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 1 $4,785.20

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Scranton--Wilkes-Barre, PA E0371 And Width new unit 0.0112288270 1 1 $3,943.40

Purchase of one (1) Scranton--Wilkes-Barre, PA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,481.50

Purchase of one (1) Scranton--Wilkes-Barre, PA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 161 60 $6,513.20

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 14 5 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Seattle-Tacoma-Bellevue, WA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) South-West-Chicago-Metro CBA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 183 82 $6,512.60

Purchase of one (1) South-West-Chicago-Metro CBA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) South-West-Chicago-Metro CBA E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) South-West-Chicago-Metro CBA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) South-West-Chicago-Metro CBA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,973.10

Purchase of one (1) Southern NY Metro CBA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 615 268 $5,975.70

Purchase of one (1) Southern NY Metro CBA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 5 2 $4,685.30

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Southern NY Metro CBA E0371 And Width new unit 0.0112288270 18 7 $3,861.40

Purchase of one (1) Southern NY Metro CBA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 3 1 $5,367.30

Purchase of one (1) Southern NY Metro CBA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,048.90

Purchase of one (1) Springfield, MA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 41 16 $6,512.60

Purchase of one (1) Springfield, MA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 6 2 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Springfield, MA E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Springfield, MA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Springfield, MA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) St. Louis, MO-IL E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 272 127 $6,512.60

Page 15: DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10 Purchase of one (1)

Your Bid 2010 Beneficiary Your 2010 Allowed Weight Your Cost to AmountCount Bid Limit Estimated (The relative market Units (To provide one [1]

(Number of (2012 Fee Purchase HCPCS Definition of (Number of units unit as described in Capacity

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

category based on HCPCS code paid Bidding Unit; CBA that received be at or below than your bid furnish in the utilization) by Medicare in CY should include cost the product in CY this amount)

2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Purchase of one (1) St. Louis, MO-IL E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 11 6 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) St. Louis, MO-IL E0371 And Width new unit 0.0112288270 56 23 $4,114.90

Purchase of one (1) St. Louis, MO-IL E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) St. Louis, MO-IL E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,973.10

Purchase of one (1) Stockton, CA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 34 13 $6,513.00

Purchase of one (1) Stockton, CA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 1 $4,756.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Stockton, CA E0371 And Width new unit 0.0112288270 1 1 $3,920.00

Purchase of one (1) Stockton, CA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,448.90

Purchase of one (1) Stockton, CA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Suffolk County CBA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 223 107 $6,512.60

Purchase of one (1) Suffolk County CBA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 2 $4,841.80

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Suffolk County CBA E0371 And Width new unit 0.0112288270 2 1 $3,990.20

Purchase of one (1) Suffolk County CBA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 6 2 $5,546.40

Purchase of one (1) Suffolk County CBA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,293.60

Purchase of one (1) Syracuse, NY E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 18 10 $6,512.60

Purchase of one (1) Syracuse, NY E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,841.80

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Syracuse, NY E0371 And Width new unit 0.0112288270 12 7 $3,990.20

Purchase of one (1) Syracuse, NY E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,546.40

Purchase of one (1) Syracuse, NY E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,293.60

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 293 111 $6,435.00

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 17 5 $4,570.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0371 And Width new unit 0.0112288270 1 1 $3,766.70

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 3 1 $5,235.60

Purchase of one (1) Tampa-St. Petersburg-Clearwater, FL E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,469.10

Purchase of one (1) Toledo, OH E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 46 21 $6,512.60

Purchase of one (1) Toledo, OH E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Toledo, OH E0371 And Width new unit 0.0112288270 21 10 $4,114.90

Purchase of one (1) Toledo, OH E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Toledo, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 9 3 $8,364.10

Purchase of one (1) Tucson, AZ E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 39 17 $5,975.70

Purchase of one (1) Tucson, AZ E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,634.00

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Tucson, AZ E0371 And Width new unit 0.0112288270 1 1 $3,819.10

Purchase of one (1) Tucson, AZ E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,308.60

Purchase of one (1) Tucson, AZ E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,819.40

Purchase of one (1) Tulsa, OK E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 64 28 $6,512.60

Purchase of one (1) Tulsa, OK E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 2 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Tulsa, OK E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Tulsa, OK E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Tulsa, OK E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,280.00

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 230 97 $6,512.60

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 6 2 $4,993.10

Page 16: DMEPOS Competitive Bidding Program Bid Preparation ... · Akron, OH E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10 Purchase of one (1)

Your Bid 2010 Beneficiary Your 2010 Allowed Weight Your Cost to AmountCount Bid Limit Estimated (The relative market Units (To provide one [1]

(Number of (2012 Fee Purchase HCPCS Definition of (Number of units unit as described in Capacity

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

category based on HCPCS code paid Bidding Unit; CBA that received be at or below than your bid furnish in the utilization) by Medicare in CY should include cost the product in CY this amount)

2010) amount) to buy unit, CBA for one [1]2010) overhead and profit) year)

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0371 And Width new unit 0.0112288270 2 1 $4,114.90

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 2 1 $5,688.70

Purchase of one (1) Virginia Beach-Norfolk-Newport News, VA-NC E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Visalia-Porterville, CA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 60 28 $6,513.00

Purchase of one (1) Visalia-Porterville, CA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,756.50

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Visalia-Porterville, CA E0371 And Width new unit 0.0112288270 1 1 $3,920.00

Purchase of one (1) Visalia-Porterville, CA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,448.90

Purchase of one (1) Visalia-Porterville, CA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 425 184 $6,512.60Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 14 4 $4,714.00Washington-Arlington-Alexandria, DC-VA-MD- Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) WV E0371 And Width new unit 0.0112288270 3 1 $3,885.00Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,399.90Washington-Arlington-Alexandria, DC-VA-MD- Purchase of one (1) WV E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $7,856.30

Purchase of one (1) Wichita, KS E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 55 19 $6,512.60

Purchase of one (1) Wichita, KS E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Wichita, KS E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Wichita, KS E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Wichita, KS E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Worcester, MA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 28 13 $6,512.60

Purchase of one (1) Worcester, MA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 3 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Worcester, MA E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Worcester, MA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Worcester, MA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10

Purchase of one (1) Youngstown-Warren-Boardman, OH-PA E0277 Powered Pressure-Reducing Air Mattress new unit 0.9566072448 56 22 $6,512.60

Purchase of one (1) Youngstown-Warren-Boardman, OH-PA E0372 Powered Air Overlay For Mattress, Standard Mattress Length And Width new unit 0.0204910233 1 1 $4,993.10

Nonpowered Advanced Pressure Reducing Overlay For Mattress, Standard Mattress Length Purchase of one (1) Youngstown-Warren-Boardman, OH-PA E0371 And Width new unit 0.0112288270 1 1 $4,114.90

Purchase of one (1) Youngstown-Warren-Boardman, OH-PA E0373 Nonpowered Advanced Pressure Reducing Mattress new unit 0.0058998922 1 1 $5,688.70

Purchase of one (1) Youngstown-Warren-Boardman, OH-PA E0193 Powered Air Flotation Bed (Low Air Loss Therapy) new unit 0.0057730128 1 1 $8,364.10