02._25WS0022_-_Rate_Sheet.xlsx
XLSX spreadsheet 32 KB Posted
- Solicitation number
- 0000034762
About this file
This is a Rate Sheet for the California Department of Veterans Affairs (CalVA) Solicitation Number 25WS0022, which covers diagnostic services for the Veterans Home of California - West Los Angeles. The solicitation seeks comprehensive diagnostic services including Radiology, Ultrasound, and Laboratory/Phlebotomy Services, with estimated procedure volumes across multiple medical imaging and testing categories. The contract will serve the Veterans Home located at 11500 Nimitz Avenue in Los Angeles, with estimated procedure volumes including 35-70 procedures for various radiology services, 10-40 ultrasound procedures, and 576-900 laboratory tests per contract term.
The rate sheet provides a detailed pricing structure based on a percentage of Medicare rates, with bidders required to complete yellow-highlighted sections specifying their proposed rates. The document mandates submission of the rate sheet and warns that altering the document could result in quote rejection. Additional billable services include after-hours procedures, STAT fees, and transportation fees for different patient group sizes. The pricing model allows for an all-inclusive rate, with zero-dollar entries interpreted as services provided at no cost to the state. The contract includes provisions for potential volume adjustments and does not guarantee a specific service volume, with rates remaining binding for the agreement's term, including potential extensions through formal amendments.
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Rate Sheet
| California Department of Veterans Affairs | Solicitation Number: 25WS0022 |
| Rate Sheet | |
| Diagnostic Services: Radiology, Ultrasound and Laboratory/Phlebotomy Services |
Submission of this attachment is MANDATORY. Upon award, the quote below will become part of the Agreement in Exhibit B-1, Rate Sheet. The proposer shall enter the rates in the yellow-highlighted section below. An all-inclusive rate is required for the items listed. A zero dollar ($0.00) amount entered for any and all items will be understood by the State that the proposer will perform any such services at no cost to the State. However, failure to indicate a dollar amount in any item may be grounds to reject the entire quote. Altering this document shall result in the proposer's quote being rejected.
The Basis of the Award shall be used to determine the lowest responsible quote. The State makes no guarantee, expressed or implied, on the actual amount of services that shall be required for this Agreement and is subject to change based on the needs of the Home. However, the rates quoted by the proposer shall be binding for the term of the Agreement, including any extension of the term through a formal amendment.
| Enter the bid in the yellow-highlighted area. | ||||||||
| RADIOLOGY | Sample Procedures | Average Medicare Rate / Proc. | x | Estimated Number of Procedures for the Contract Term | x | % of Medicare | = | Subtotals |
| Mandible | $ 43.59 | x | 35 | x | = | $ - 0 | ||
| Facial Bones < 3 Views | $ 35.82 | x | 35 | x | = | $ - 0 | ||
| Nasal Bones Min. 3 Views | $ 42.48 | x | 35 | x | = | $ - 0 | ||
| Paranasal Sinuses < 3 Views | $ 36.30 | x | 35 | x | = | $ - 0 | ||
| Skull < 4 Views | $ 40.50 | x | 35 | x | = | $ - 0 | ||
| Chest 1 View | $ 28.91 | x | 70 | x | = | $ - 0 | ||
| Chest 2 Views | $ 37.60 | x | 70 | x | = | $ - 0 | ||
| Ribs Unilateral 2 Views | $ 41.08 | x | 70 | x | = | $ - 0 | ||
| Ribs Bilat. AP Chest | $ 58.57 | x | 70 | x | = | $ - 0 | ||
| Sternum Min 2 Views | $ 37.31 | x | 35 | x | = | $ - 0 | ||
| Spine Cervical AP/Lateral | $ 44.55 | x | 35 | x | = | $ - 0 | ||
| Spine Thoracic AP/Lateral | $ 36.93 | x | 35 | x | = | $ - 0 | ||
| Spine Thoarcoulumbar | $ 38.81 | x | 35 | x | = | $ - 0 | ||
| Spine Lumbosacral AP/Lateral | $ 44.55 | x | 35 | x | = | $ - 0 | ||
| Pelvis AP View | $ 31.28 | x | 35 | x | = | $ - 0 | ||
| Sacroiliac Joint < 4 Views | $ 37.85 | x | 35 | x | = | $ - 0 | ||
| Sacrum/Coccyx Min 2 Views | $ 36.69 | x | 35 | x | = | $ - 0 | ||
| Clavicle Complete | $ 36.74 | x | 35 | x | = | $ - 0 | ||
| Scapula Complete | $ 26.65 | x | 35 | x | = | $ - 0 | ||
| Shoulder Comp. Min. 2 Views | $ 38.96 | x | 35 | x | = | $ - 0 | ||
| Humerus Min. 2 Views | $ 35.96 | x | 35 | x | = | $ - 0 | ||
| Elbow AP/Lateral Views | $ 32.87 | x | 70 | x | = | $ - 0 | ||
| Forearm AP/Lateral Views | $ 32.87 | x | 70 | x | = | $ - 0 | ||
| Wrist AP/Lateral Views | $ 37.90 | x | 70 | x | = | $ - 0 | ||
| Hand 2 Views | $ 35.19 | x | 70 | x | = | $ - 0 | ||
| Finger/Fingers Min. 2 Views | $ 43.45 | x | 70 | x | = | $ - 0 | ||
| Hip Min Unilateral 2 Views | $ 53.82 | x | 70 | x | = | $ - 0 | ||
| Hips Bilateral 2 Views/each | $ 60.82 | x | 70 | x | = | $ - 0 | ||
| Femur 2 Views | $ 40.11 | x | 70 | x | = | $ - 0 | ||
| Knee AP/Lateral Views | $ 38.28 | x | 70 | x | = | $ - 0 | ||
| Knees Bilateral 2 Views/each | $ 45.23 | x | 70 | x | = | $ - 0 | ||
| Tibia/Fibula AP/Lateral | $ 35.58 | x | 70 | x | = | $ - 0 | ||
| Ankle AP/Lateral Views | $ 35.96 | x | 70 | x | = | $ - 0 | ||
| Foot AP/Lateral Views | $ 31.72 | x | 70 | x | = | $ - 0 | ||
| Foot Complt. Min 3 Views | $ 38.23 | x | 70 | x | = | $ - 0 | ||
| Calcaneus Min. 2 Views | $ 31.72 | x | 35 | x | = | $ - 0 | ||
| Toe/Toes Min. 2 Views | $ 32.64 | x | 35 | x | = | $ - 0 | ||
| Abdomen Single AP View | $ 33.55 | x | 70 | x | = | $ - 0 | ||
| UTLRASOUND | Sample Procedures | Average Medicare Rate / Proc. | x | Estimated Number of Procedures for the Contract Term | x | % of Medicare | = | Subtotals |
| Thyroid | $ 115.91 | x | 10 | x | = | $ - 0 | ||
| US Chest Mediastinum | $ 61.49 | x | 10 | x | = | $ - 0 | ||
| Breast Ultrasound | $ 108.14 | x | 10 | x | = | $ - 0 | ||
| Abdominal Ultrasound | $ 122.27 | x | 10 | x | = | $ - 0 | ||
| Abdomin ITD | $ 91.88 | x | 10 | x | = | $ - 0 | ||
| Retroperitoneal Ultrasound | $ 114.14 | x | 10 | x | = | $ - 0 | ||
| Pelvis Ultrasound | $ 110.96 | x | 10 | x | = | $ - 0 | ||
| Urinary Bladder Ultrasound | $ 53.01 | x | 40 | x | = | $ - 0 | ||
| Scrotum Ultrasound | $ 105.66 | x | 10 | x | = | $ - 0 | ||
| Echocardio M-Mode2D | $ 205.32 | x | 10 | x | = | $ - 0 | ||
| Cartid Artery Profile | $ 198.60 | x | 10 | x | = | $ - 0 | ||
| Ankle Brachial Index | $ 86.58 | x | 10 | x | = | $ - 0 | ||
| Lower Bil. Arterial Doppler | $ 137.47 | x | 10 | x | = | $ - 0 | ||
| Lower Uni. Arterial Right | $ 150.19 | x | 10 | x | = | $ - 0 | ||
| Upperr Bil. Venous Doppler | $ 208.50 | x | 10 | x | = | $ - 0 | ||
| Upper Uni. Venous- LT | $ 129.34 | x | 20 | x | = | $ - 0 | ||
| Lower Bil. Venous Doppler | $ 195.42 | x | 10 | x | = | $ - 0 | ||
| Lower Uni. Venous-LT | $ 125.10 | x | 10 | x | = | $ - 0 | ||
| Flow In/ Out Abd. Organs | $ 275.99 | x | 10 | x | = | $ - 0 | ||
| Flow In/ Out Abd. Organs ITD | $ 167.15 | x | 10 | x | = | $ - 0 | ||
| Duplex Scan Aort./ Vena Cav | $ 190.12 | x | 10 | x | = | $ - 0 | ||
| Hemodialysis Access | $ 153.37 | x | 10 | x | = | $ - 0 | ||
| Phlebotomy & Laboratory | Sample Procedures | Average Medicare Rate / Proc. | x | Estimated Number of Procedures for the Contract Term | x | % of Medicare | = | Subtotals |
| Basic Metabolic | $7.27 | x | 900 | x | = | $ - 0 | ||
| Comp Metabolic | $9.19 | x | 792 | x | = | $ - 0 | ||
| Lipid Panel | $11.54 | x | 576 | x | = | $ - 0 | ||
| CBC w/ diff | $6.75 | x | 576 | x | = | $ - 0 | ||
| Ferritin | $12.07 | x | 576 | x | = | $ - 0 | ||
| Folate | $13.07 | x | 576 | x | = | $ - 0 | ||
| Hemoglobin | $2.07 | x | 576 | x | = | $ - 0 | ||
| Iron, Total | $5.72 | x | 576 | x | = | $ - 0 | ||
| Iron (TIBC) | $6.89 | x | 576 | x | = | $ - 0 | ||
| PSA, Total | $16.35 | x | 576 | x | = | $ - 0 | ||
| PT/INR | $3.49 | x | 576 | x | = | $ - 0 | ||
| TSH 3rd gen | $14.76 | x | 576 | x | = | $ - 0 | ||
| UA w/microscopy | $2.77 | x | 576 | x | = | $ - 0 | ||
| Vit B12 | $13.33 | x | 576 | x | = | $ - 0 | ||
| Vit D, 25-OH | $20.72 | x | 576 | x | = | $ - 0 | ||
| Urine Culture | $6.08 | x | 576 | x | = | $ - 0 | ||
| Other Procedures | Estimated Numbers for the Contract Term | Rate per Item | Subtotals | |||||
| Employee Chest/per Procedure | 60 | x | = | $ - 0 | ||||
| After Hours (Outside of M-F 9:00-17:00) | 720 | x | = | $ - 0 | ||||
| STAT Fee (Laboratory) | 576 | x | = | $ - 0 | ||||
| STAT Charge / Per patient / Per visit (Laboratory) | 576 | x | = | $ - 0 | ||||
| STAT Fee for Radiology Services | 280 | x | = | $ - 0 | ||||
| STAT Charge / Per patient / Per visit (Radiology) | 280 | x | = | $ - 0 | ||||
| Transportation Fee 1 Patient for Radiology Services | 70 | x | = | $ - 0 | ||||
| Transportation Fee 2 Patients for Radiology Services | 35 | x | = | $ - 0 | ||||
| Transportation Fee 3 Patients for Radiology Services | 35 | x | = | $ - 0 | ||||
| Transportation Fee 4 Patients for Radiology Services | 35 | x | = | $ - 0 | ||||
| Transportation Fee 5 Patients for Radiology Services | 35 | x | = | $ - 0 | ||||
| Transportation Fee 6 or more Patients for Radiology Services | 35 | x | = | $ - 0 | ||||
| Set Up Fee/per Procedure for Radiology Services | 70 | x | = | $ - 0 | ||||
| Transportation Fee 1 Patient for Ultrasound Services | 70 | x | = | $ - 0 | ||||
| Transportation Fee 2 Patients for Ultrasound Services | 35 | x | = | $ - 0 | ||||
| Transportation Fee 3 Patients for Ultrasound Services | 35 | x | = | $ - 0 | ||||
| Transportation Fee 4 Patients for Ultrasound Services | 35 | x | = | $ - 0 | ||||
| Transportation Fee 5 Patients for Ultrasound Services | 35 | x | = | $ - 0 | ||||
| Transportation Fee 6 or more Patients for Ultrasound Services | 35 | x | = | $ - 0 | ||||
| Set Up Fee/per Procedure for Ultrasound Services | 70 | x | = | $ - 0 | ||||
| Transportation Fee 1 Patient for Phlebotomy & Laboratory Services | 70 | x | = | $ - 0 | ||||
| Transportation Fee 2 Patients for Phlebotomy & Laboratory Services | 35 | x | = | $ - 0 | ||||
| Transportation Fee 3 Patients for Phlebotomy & Laboratory Services | 35 | x | = | $ - 0 | ||||
| Transportation Fee 4 Patients for Phlebotomy & Laboratory Services | 35 | x | = | $ - 0 | ||||
| Transportation Fee 5 Patients for Phlebotomy & Laboratory Services | 35 | x | = | $ - 0 | ||||
| Transportation Fee 6 or more Patients for Phlebotomy & Laboratory Services | 35 | x | = | $ - 0 | ||||
| Set Up Fee/per Procedure for Phlebotomy & Laboratory Services | 70 | x | = | $ - 0 | ||||
| Sub-Total (Sum of 1-113) | $ - 0 |
| Total Amount of Contract | $ - 0 |
| Basis of Award |
The undersigned Contractor hereby proposes to furnish all travel, labor, licenses, permits, certifications, and any other item of expense to perform services for the residents at the Veterans Home of California – West Los Angeles located at: 11500 Nimitz Avenue Los Angeles, CA 90049 in accordance with the specifications and provisions stated in the solicitation package.
This Rate Sheet MUST be signed and returned.
The bid must be transmitted in accordance with the solicitation instructions.
Company Name Email address of Representative
Printed Name and Title Signature Date
Address City, State, and ZIP
Telephone Number Fax Number
File details come from the government source that posted it. Updated .