26CRY001_-_Bid_Rate_Sheet.xlsm
XLSM spreadsheet 32 KB Posted
- Solicitation number
- 0000040110
- Issued by
- California
About this file
This is a bid rate sheet for mobile radiology and ultrasound services submitted to the California Department of Veterans Affairs for contract solicitation 26CRY001 at the Veterans Home of California in Yountville. The sheet establishes the pricing structure for both ultrasound and radiology procedures that bidders must complete and submit as a mandatory attachment. The ultrasound section includes 23 line items covering diagnostic procedures such as thyroid, breast, abdominal, pelvic, vascular doppler, and echocardiography services, with estimated procedure volumes ranging from 2 to 50 procedures over the contract term based on historical usage patterns. The radiology section encompasses 49 line items including skeletal radiography, chest imaging, spine films, and transportation fees for patient movement, with estimated procedure volumes ranging from 1 to 200 procedures based on prior year data. The rate sheet provides Medicare benchmark rates for reference but requires bidders to input their own pricing percentages and total costs in designated yellow cells.
Bidders must establish rates for each procedure line item, with blank submissions understood to indicate services provided at no cost. Rates submitted become binding for the entire contract term and form part of Exhibit B-Budget Detail and Payment Provisions upon award. The state reserves the right to modify the actual volume and scope of services based on resident population fluctuations and operational needs, and makes no guarantee regarding minimum service levels. The grand total of all line items serves as the basis of award and will be used to calculate the lowest responsible bid, with application of small business preferences where applicable. Transportation fees include tiered pricing for moving multiple patients per trip, with additional line items for employee chest X-rays, after-hours fees, and STAT (stat priority) fees per patient visit.
View the file
Other files
Show all 15
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
LAB X-Ray Ultrasound
RATE SHEET
Submission of this attachment is MANDATORY. Upon award, bid below will become part of the Agreement in Exhibit B-Budget Detail and Payment Provisions. The Bidder shall set forth the rates in the yellow spaces provided. Failure to indicate an amount for any item will be understood by the State that the Bidder will provide the item at no cost.
The Basis of Award shall be used to determine the lowest responsible bids.
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 needs of the Home. However, the rates quoted by Bidder shall be binding for the term of the Agreement.
The State does not expressly or by implication agree that the actual amount of work will correspond therewith and reserves the right to omit portions of the work, as may be deemed necessary or advisable, by the State. The sample procedures listed below are some of the procedures utilized in prior years but are not an all inclusive list. The samples will be used to determine a total dollar amount for the Basis of Award to apply to the Small Business Preference when applicable. This is not a guarantee of business, or specific services to be provided, and is subject to change depending on CalVet’s fluctuations in the resident population. Rate of payment will be the rates submitted in yellow spaces below.
| ULTRASOUND | Sample Procedures | Estimated # of Procedures for the Contract Term | Average Medicare Rate/ Proc. | % of Medicare | Total | ||||
| 1 | 76536 | Thyroid | 10 | x | $ 115.91 | x | = | $ - 0 | |
| 2 | 76604 | US Chest Mediastinum | 10 | x | $ 61.49 | x | = | $ - 0 | |
| 3 | 76641 | Breast Ultrasound | 10 | x | $ 108.14 | x | = | $ - 0 | |
| 4 | 76700 | Abdominal Ultrasound | 10 | x | $ 122.27 | x | = | $ - 0 | |
| 5 | 76705 | Abdomen ITD | 10 | x | $ 91.88 | x | = | $ - 0 | |
| 6 | 76770 | Retroperitoneal Ultrasound | 10 | x | $ 114.14 | x | = | $ - 0 | |
| 7 | 76856 | Pelvis Ultrasound | 10 | x | $ 110.96 | x | = | $ - 0 | |
| 8 | 76857 | Urinary Bladder Ultrasound | 40 | x | $ 53.01 | x | = | $ - 0 | |
| 9 | 76870 | Scrotum Ultrasound | 10 | x | $ 105.66 | x | = | $ - 0 | |
| 10 | 93306 | Echocardio M-Mode 2D | 10 | x | $ 205.32 | x | = | $ - 0 | |
| 11 | 93880 | Carotid Artery Profile | 10 | x | $ 198.60 | x | = | $ - 0 | |
| 12 | 93922 | Ankle Brachial Index | 10 | x | $ 86.58 | x | = | $ - 0 | |
| 13 | 93825 | Lower Bil. Arterial Doppler | 10 | x | $ 137.47 | x | = | $ - 0 | |
| 14 | 93926 | Lower Uni. Arterial-right | 10 | x | $ 150.19 | x | = | $ - 0 | |
| 15 | 93930 | Upper Bil. Arterial Doppler | 10 | x | $ 208.50 | x | = | $ - 0 | |
| 16 | 93931 | Upper Uni. Arterial-Right | 20 | x | $ 129.34 | x | = | $ - 0 | |
| 17 | 93970 | Lower Bil. Venous Doppler | 10 | x | $ 195.42 | x | = | $ - 0 | |
| 18 | 93971 | Lower Uni. Venous-LT | 10 | x | $ 125.10 | x | = | $ - 0 | |
| 19 | 93975 | Flow In/Out Abd. Organs | 10 | x | $ 275.99 | x | = | $ - 0 | |
| 20 | 93976 | Flow In/Out Abd. Organs ITD | 10 | x | $ 167.15 | x | = | $ - 0 | |
| 21 | 93978 | Duplex Scan Aort./Vena Cav. | 10 | x | $ 190.12 | x | = | $ - 0 | |
| 22 | 93990 | Hemodialysis Access | 10 | x | $ 153.37 | x | = | $ - 0 | |
| ULTRASOUND | Other Procedures | Estimated #s for the Contract Term | Rate per Item | Total | |||||
| 23 | STAT fee per patient, per visit | 50 | x | = | $ - 0 | ||||
| TOTAL (#1 thru #23) | = | $ - 0 | |||||||
| RADIOLOGY | Sample Procedure | Estimated # of Procedures for the Contract Term | Average Medicare Rate/ Proc. | % of Medicare | Total | ||||
| 1 | 70100 | Mandible | 35 | x | $ 43.59 | x | = | $ - 0 | |
| 2 | 70140 | Facial Bones < 3 Views | 35 | x | $ 35.82 | x | = | $ - 0 | |
| 3 | 70160 | Nasal Bones Min. 3 Views | 35 | x | $ 42.48 | x | = | $ - 0 | |
| 4 | 70210 | Paranasal Sinuses < 3 Views | 35 | x | $ 36.30 | x | = | $ - 0 | |
| 5 | 70250 | Skull < 4 Views | 35 | x | $ 40.50 | x | = | $ - 0 | |
| 6 | 71045 | Chest 1 View | 200 | x | $ 28.91 | x | = | $ - 0 | |
| 7 | 71046 | Chest 2 Views | 200 | x | $ 37.60 | x | = | $ - 0 | |
| 8 | 71100 | Ribs Unilateral 2 Views | 70 | x | $ 41.08 | x | = | $ - 0 | |
| 9 | 71111 | Ribs Bilat. AP Chest | 70 | x | $ 58.57 | x | = | $ - 0 | |
| 10 | 71120 | Sternum Min 2 Views | 35 | x | $ 37.31 | x | = | $ - 0 | |
| 11 | 72040 | Spine Cervical AP/Lateral | 35 | x | $ 44.55 | x | = | $ - 0 | |
| 12 | 72070 | Spine Thoracic AP/Lateral | 35 | x | $ 36.93 | x | = | $ - 0 | |
| 13 | 72080 | Spine Thoarcoulumbar | 35 | x | $ 38.81 | x | = | $ - 0 | |
| 14 | 72100 | Spine Lumbosacral AP/Lateral | 35 | x | $ 44.55 | x | = | $ - 0 | |
| 15 | 72170 | Pelvis AP View | 35 | x | $ 36.93 | x | = | $ - 0 | |
| 16 | 72200 | Sacroiliac Joint < 4 Views | 35 | x | $ 38.81 | x | = | $ - 0 | |
| 17 | 72220 | Sacrum/Coccyx Min 2 Views | 35 | x | $ 44.55 | x | = | $ - 0 | |
| 18 | 73000 | Clavicle Complete | 35 | x | $ 31.28 | x | = | $ - 0 | |
| 19 | 73010 | Scapula Complete | 35 | x | $ 26.65 | x | = | $ - 0 | |
| 20 | 73030 | Shoulder Comp. Min. 2 Views | 35 | x | $ 38.96 | x | = | $ - 0 | |
| 21 | 73060 | Humerus Min. 2 Views | 35 | x | $ 32.87 | x | = | $ - 0 | |
| 22 | 73070 | Elbow AP/Lateral Views | 35 | x | $ 32.87 | x | = | $ - 0 | |
| 23 | 73090 | Forearm AP/Lateral Views | 35 | x | $ 32.87 | x | = | $ - 0 | |
| 24 | 73100 | Wrist AP/Lateral Views | 35 | x | $ 37.90 | x | = | $ - 0 | |
| 25 | 73120 | Hand 2 Views | 35 | x | $ 35.19 | x | = | $ - 0 | |
| 26 | 73120 | Hand 2 Views | 35 | x | $ 35.19 | x | = | $ - 0 | |
| 27 | 73140 | Finger/Fingers Min. 2 Views | 35 | x | $ 43.45 | x | = | $ - 0 | |
| 28 | 73502 | Hip Min Unilateral 2 Views | 35 | x | $ 53.82 | x | = | $ - 0 | |
| 29 | 73522 | Hips Bilateral 2 Views/each | 35 | x | $ 60.82 | x | = | $ - 0 | |
| 30 | 73552 | Femur 2 Views | 35 | x | $ 40.11 | x | = | $ - 0 | |
| 31 | 73560 | Knee AP/Lateral Views | 35 | x | $ 38.28 | x | = | $ - 0 | |
| 32 | 73565 | Knees Bilateral 2 Views/each | 35 | x | $ 45.23 | x | = | $ - 0 | |
| 33 | 73590 | Tibia/Fibula AP/Lateral | 35 | x | $ 35.58 | x | = | $ - 0 | |
| 34 | 73600 | Ankle AP/Lateral Views | 35 | x | $ 36.96 | x | = | $ - 0 | |
| 35 | 73620 | Foot AP/Lateral Views | 35 | x | $ 31.72 | x | = | $ - 0 | |
| 36 | 73630 | Foot Complt. Min 3 Views | 35 | x | $ 32.64 | x | = | $ - 0 | |
| 37 | 73650 | Calcaneus Min. 2 Views | 35 | x | $ 33.55 | x | = | $ - 0 | |
| RADIOLOGY | Sample Procedure | Estimated # of Procedures for the Contract Term | Average Medicare Rate/ Proc. | % of Medicare (same as page 2) | Total | ||||
| 38 | 73660 | Toe/Toes Min. 2 Views | 30 | x | $ 32.64 | x | = | $ - 0 | |
| 39 | 74018 | Abdomen Single AP View | 60 | x | $ 33.55 | x | = | $ - 0 | |
| 40 | R0070 | Transportation Fee 1 Patient | 70 | x | $ 277.60 | x | = | $ - 0 | |
| 41 | R0075-UN | Transportation Fee 2 Patients * | 35 | x | $ 277.60 | x | = | $ - 0 | |
| 42 | R0075-UP | Transportation Fee 3 Patients * | 35 | x | $ 277.60 | x | = | $ - 0 | |
| 43 | R0075-UQ | Transportation Fee 4 Patients * | 35 | x | $ 277.60 | x | = | $ - 0 | |
| 44 | R0075-UR | Transportation Fee 5 Patients * | 50 | x | $ 277.60 | x | = | $ - 0 | |
| 45 | R0075-US | Transportation Fee 6 or more Patients * | 25 | x | $ 277.60 | x | = | $ - 0 | |
| 46 | Q0092 | Set Up Fee per procedure | 70 | x | $ 30.33 | x | = | $ - 0 | |
| TOTAL (#1 thru #46) | = | $ - 0 | |||||||
| * | Note: Rates are divided between patients and bill appropriat portion per patient. | ||||||||
| RADIOLOGY | Other Procedures | Estimated Numbers for the Contract Term | Rate per Item | Total | |||||
| 47 | Employee Chest per procedure | 10 | x | = | $ - 0 | ||||
| 48 | After Hours fee per trip | 200 | x | = | $ - 0 | ||||
| 49 | STAT fee per patient, per visit | 200 | x | = | $ - 0 | ||||
| TOTAL (#47 thru #49) | = | $ - 0 |
| Basis of Award | GRAND TOTAL | |||
| (All Line Items) | $ - 0 | |||
| * |
California Department of Veterans Affairs Solicitation Number: 26CRY001
Page &P of &N
File details come from the government source that posted it. Updated .