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ATTACHMENT 8: PRICE/COST SCHEDULE
?.## SCHEDULE OF SERVICES
The Contractor shall furnish all key personnel to provide services necessary to perform Tele-Radiology Physician Services to eligible beneficiaries of the Department of Veterans Affairs, Department of Veterans Affairs (VA) and the VA Portland Healthcare System (VAPORHCS).
The VA Radiology Services follow the standards & guidelines set forth by American College of Radiology (ACR). A contractor providing Tele-radiology services shall provide services that meet or exceed the American College of Radiology Guidelines Practice Parameters and Technical Standards | American College of Radiology (acr.org).
Place of Performance: Services shall be provided to the VAPORHCS, 3710 SW US Veterans Hospital Road, Portland OR 97207 from contractor facility.
Pricing Instructions:
Offerors must fill out the cells in the following columns in the Price Schedule for each Line-Item Number (LIN). For pricing and evaluation purposes, the current CMS rates should be used in completing each LIN for the base year. The same rates must be entered for option years.
Throughout the life of the contract the VA will pay the awarded firm fixed percentage of the Medicare rate effective at the time the service is provided by the Contractor.
This basis of the contractor’s proposed firm fixed percentage of Medicare rate will be used by the Government for future pricing of additional codes/procedures and for reimbursement under the contract. The basis of estimate used for your fixed price, i.e. the way that your price is calculated, shall remain the same throughout the life of the contract and may be validated by post award audits.
The Offeror shall complete the attached price schedule for the performance location proposed. No LINS or codes should be left blank. If for some reason a code on the schedule has expired or is for any other reason unusable, offerors shall annotate the Price per Code block with “N/A” or otherwise notate the replacement code.
The Offeror shall base pricing on the application of Medicare reimbursement rules. All spreadsheets must be submitted in Microsoft Excel and without protected/locked portions or other methods which prevent or do not facilitate expeditious pricing validation. PDF files and similarly constructed files are not acceptable.
Indicate source for CMS rate proposed (Identify source and Internet link): ________________________ Indicate the offeror’s CMS practice expense (PE) designation for the rate proposed: (facility or non-facility):
Period of Performance: BASE: 08/01/2026 – 07/31/2027
| LIN No. |
| CPT Code |
| Mod |
| Description-Summary |
| Description-Detail |
| Est. |
Qty.
| Unit |
| Proposed Unit Cost |
| CMS Unit Cost |
| % of CMS rate unit cost represents |
| Estimated Total |
Annual Cost
| CT |
| CT Low Dose Cancer Screening (71271) & CT Thorax |
| CT |
| CT ABD & PELV 1/>REGNS |
| CTA |
| CT ANGIO ABDOMINAL ARTERIES W/RUNOFF |
| US |
| US Head & Neck (thyroid) |
| N/A |
| 2D Mammography Single Breast Exam |
| N/A |
| 3D Mammography single breast Exam |
| MRI |
| MRI Cardiac-cpt code 75557, 7559, 75561 |
| CT |
| COMPUTER TOMOGRAPHY, HEART WITH 75572 |
| CT |
| COMPUTER TOMOGRAPHY HEART WITH 75573 |
TOTAL FOR BASE PERIOD
Total for base performance period and all option years:
