11-DHHS26117 Attachment G Cost Proposal Sheet.xlsx

This is a Cost Proposal Sheet for Request for Proposal (RFP) 11-DHHS26117 issued by the Utah Department of Health and Human Services for Mobile MRI and CT Services to be provided at Utah State Correctional Facility. The RFP requests pricing for a comprehensive range of diagnostic imaging procedures performed on mobile MRI and CT equipment. The cost proposal includes 44 distinct procedure line items organized by anatomical region and imaging modality, including procedures such as brain imaging with and without contrast, spinal imaging (cervical, thoracic, and lumbar), extremity imaging, pelvis imaging, orbits/face/neck imaging, and specialized procedures such as MRCP. Each procedure is identified by CPT code and specified as a per-exam unit of measure. The document establishes that offerors must enter pricing only in designated shaded cells and must not alter the format of the cost proposal sheet, with any deviation potentially resulting in disqualification.

The cost proposal requires offerors to submit unit prices for each procedure line item, with evaluation based on the sum of specific cells representing total costs across all procedures. The pricing must encompass all direct and indirect costs associated with performing the required services, with no additional fees permitted to be charged. The document specifies that the quantities listed are for RFP evaluation purposes only and that actual service quantities may differ from those used for cost evaluation. The format also includes a section for Other Procedures with blank fields for pricing, allowing offerors to propose additional services beyond the standard line items. Offerors are instructed that submission must comply strictly with the prescribed format to avoid disqualification from consideration.