Price Cost excel worksheet.xlsx
XLSX spreadsheet 22 KB Posted
- Solicitation number
- 36C26026Q0869
About this file
This is a pricing cost worksheet for a teleradiology services solicitation issued by VA Portland Healthcare System (VAPORHCS) for the base year period of September 1, 2026 through August 31, 2027. The worksheet outlines 20 line items representing diagnostic imaging services with estimated quantities and unit pricing fields, though all unit prices are currently listed at $0.00. The services encompass a comprehensive range of radiology modalities including plain films (2,900 exams), CT exams (1,750 general exams plus specialized variants totaling approximately 1,570 additional exams across multiple anatomical regions), ultrasound services (50 general exams plus 20 specialized exams), MRI services (100 general exams plus 65 specialized exams), and nuclear medicine/PET-CT services (40 total exams). The total estimated annual volume is 6,500 exams across all service categories.
The worksheet provides detailed CPT code mappings for each service category, establishing the specific procedural codes and anatomical areas covered under each line item. These codes range from basic radiographic procedures (such as mandible and chest X-rays) to advanced imaging including CTA exams, cardiac MRI, coronary CT angiography, and specialized nuclear medicine procedures such as hepatobiliary imaging and renal function studies. This pricing template serves as the basis for vendor quotation submissions in response to solicitation 36C26026Q0869, which is a small business set-aside for Service-Disabled Veteran-Owned Businesses (SDVOSB) under NAICS code 621512 (Diagnostic Imaging Centers).
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26026Q0869 0003.pdf | ||
| Amendment_A0001_QA_36C26026Q0869.docx | DOCX document | |
| 36C26026Q0869 0003_1.docx | DOCX document | |
| ATTACHMENT 6 ORGANIZATIONAL CONFLICT OF INTEREST STATEMENT 8.20.2026.docx | DOCX document | |
| ATTACHMENT 8 PRICE COST SCHEDULE 8.14.2026.docx | DOCX document | |
| 36C26026Q0869 0002.pdf | ||
| 36C26026Q0869 0002_1.docx | DOCX document | |
| 36C26026Q0869 0001.pdf | ||
| 36C26026Q0869 0001_1.docx | DOCX document | |
| ATTACHMENT 5 CONTRACTOR EMPLOYEE LEGAL STATUS.docx | DOCX document | |
| ATTACHMENT 6 ORGANIZATIONAL CONFLICT OF INTEREST STATEMENT.docx | DOCX document | |
| ATTACHMENT 7 CONTRACTOR RULES OF BEHAVIOR.docx | DOCX document | |
| ATTACHMENT 3 KEY PERSONNEL LISTING.docx | DOCX document | |
| ATTACHMENT 1 PERFORMANCE WORK STATEMENT.docx | DOCX document | |
| ATTACHMENT 2 QASP.docx | DOCX document | |
| ATTACHMENT 8 PRICE COST SCHEDULE.docx | DOCX document | |
| ATTACHMENT 4 PAST PERFORMANCE REFERENCES.docx | DOCX document | |
| 36C26026Q0869.docx | DOCX document |
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Text version
BASE YEAR Estimate
| BASE Year 9/1/2026 - 8/31/2027 | |||||
| Item Number | Description of Suplies/Services | Unit | Unit Price | Estimated Amount | Total Price |
| 001 | Plain Films | EA | 2900 | $0.00 | |
| 002 | CT Exams | EA | 1750 | $0.00 | |
| 003 | CT Low Dose Cancer Screening (71271) & CT Thorax | EA | 10 | $0.00 | |
| 004 | CTA Exams | EA | 650 | $0.00 | |
| 005 | CT Abd & Pelvis exams | EA | 850 | $0.00 | |
| 006 | CT ABD & PELV 1/>REGNS | EA | 10 | $0.00 | |
| 007 | CT ANGIO ABDOMINAL ARTERIES W/RUNOFF | EA | 50 | $0.00 | |
| 008 | Ultrasound (US) Exams | EA | 50 | $0.00 | |
| 009 | US Head & Neck (thyroid) | EA | 10 | $0.00 | |
| 010 | US Arterial Duplex | EA | 10 | $0.00 | |
| 011 | MR Exams | EA | 100 | $0.00 | |
| 012 | MR Abdomen Exams | EA | 25 | $0.00 | |
| 013 | NM | EA | 25 | $0.00 | |
| 014 | MR Prostate | EA | 15 | $0.00 | |
| 015 | PET/CT | EA | 15 | $0.00 | |
| 016 | 2D Mammography Single Breast Exam | EA | 0 | $0.00 | |
| 017 | 3D Mammography single breast Exam | EA | 0 | $0.00 | |
| 018 | MRI Cardiac-cpt code 75557, 7559, 75561 | EA | 10 | $0.00 | |
| 019 | COMPUTER TOMOGRAPHY, HEART WITH 75572 | EA | 10 | $0.00 | |
| 020 | COMPUTER TOMOGRAPHY HEART WITH 75573 | EA | 10 | $0.00 |
TOTAL (Base Year) 6500 $0.00
CPT Codes
| Plain Films | 2900 |
| 70100 MANDIBLE LESS THAN 4 VIEWS | |
| 70110 MANDIBLE 4 OR MORE VIEWS | |
| 70140 FACIAL BONES, 1 TO 2 VIEWS | |
| 70150 FACIAL BONES, MINIMUM OF 3 VIEWS | |
| 70160 NASAL BONES MIN 3 VIEWS | |
| 70200 ORBIT MIN 4 VIEWS | |
| 70210 SINUSES, PARANASAL, LESS THAN 3 VIEWS | |
| 70220 SINUSES, PARANASAL, MORE THAN 3 VIEWS | |
| 70250 SKULL LESS THAN 4 VIEWS | |
| 70260 SKULL 4 OR MORE VIEWS | |
| 70328 temporomandibular joint | |
| 70330 TM JOINTS BILAT O&C MOUTH | |
| 70360 NECK SOFT TISSUE | |
| 71010 PIC LINE PLACEMENT CHECK | |
| 71020 CHEST PA AND LAT W/NIPPLE MRKRS | |
| 71021 CHEST APICAL LORDOTIC | |
| 71030 chest X-ray with four or more views | |
| 71035 CHEST (DECUB) | |
| 71045 CHEST X-RAY, SINGLE VIEW | |
| 71046 CHEST X-RAY, 2 VIEWS | |
| 71047 CHEST X-RAY, 3 VIEWS | |
| 71100 RIBS UNILAT 2 VIEWS | |
| 71101 RIBS UNILAT+CHEST 3 OR MORE VIEWS | |
| 71110 RIBS BILATERAL | |
| 71111 RIBS BILATERAL + CHEST | |
| 71120 STERNUM 2 OR MORE VIEWS | |
| 71130 STERNOCLAV JOINT MIN 3 VIEWS | |
| 72020 SPINE SINGLE VIEW | |
| 72040 SPINE CERVICAL, 2 OR 3 VIEWS | |
| 72050 SPINE CERVICAL 4 OR 5 VIEWS | |
| 72052 SPINE CERVICAL 6 OR MORE VIEWS | |
| 72070 SPINE THORACIC 2 VIEWS | |
| 72072 SPINE THORACIC 2 VIEWS | |
| 72074 SPINE THORACIC 4 OR MORE VIEWS | |
| 72081 SCOLIOSIS / ENTIRE SPINE, 1 VIEW | |
| 72082 SCOLIOSIS / ENTIRE SPINE, 2 OR 3 VIEWS | |
| 72083 SCOLIOSIS / ENTIRE SPINE, 4 OR 5 VIEWS | |
| 72084 SCOLIOSIS / ENTIRE SPINE, 6 OR MORE VIEWS | |
| 72090 SPINE; scoliosis study | |
| 72100 SPINE LUMBOSACRAL MIN 2 VIEWS | |
| 72110 SPINE LUMBOSACRAL MIN 4 VIEWS | |
| 72114 SPINE LUMBOSACRAL SERIES, FLEXION, EXT | |
| 72120 SPINE, lumbosacral | |
| 72170 PELVIS, ONE OR TWO VIEWS | |
| 72190 PELVIS 3 OR MORE VIEWS | |
| 72200 SPINE SI JOINTS 1 OR 2 VIEWS | |
| 72202 SPINE SI JOINTS 3 OR MORE VIEWS | |
| 72220 SPINE SACRUM & COCCYX MIN 2 VIEWS | |
| 73000 CLAVICLE, BILATERAL | |
| 73010 SCAPULA, COMPLETE | |
| 73020 SHOULDER, SINGLE VIEW | |
| 73030 SHOULDER, TWO OR MORE VIEWS | |
| 73050 ACROMIOCLAVICULAR J BILAT | |
| 73060 HUMERUS, MINIMUM TWO VIEWS | |
| 73070 ELBOW, TWO VIEWS | |
| 73080 ELBOW, THREE OR MORE VIEWS | |
| 73090 FOREARM, TWO VIEWS | |
| 73100 WRIST, 1 OR 2 VIEWS | |
| 73110 WRIST, 3 OR MORE VIEWS | |
| 73120 HAND, 1 OR 2 VIEWS | |
| 73130 HAND, 3 OR MORE VIEWS | |
| 73140 FINGER(S) 2 OR MORE VIEWS | |
| 73501 HIP, UNILATERAL, 1 VIEW | |
| 73502 HIP, AP/LAT/ HIP CENTERED PELVIS | |
| 73503 HIP, UNILATERAL, 4 OR MORE VIEWS | |
| 73521 HIPS, BILATERAL, 2 VIEWS | |
| 73522 HIPS, BILATERAL, W/PELVIS, 3 OR 4 VIEWS | |
| 73523 HIPS, BILATERAL, 5 OR MORE VIEWS | |
| 73551 FEMUR, 1 VIEW | |
| 73552 FEMUR, LEFT - AP & LAT | |
| 73560 KNEE, 1 OR 2 VIEWS | |
| 73562 KNEE, 3 VIEWS | |
| 73564 KNEE, 4 OR MORE VIEWS | |
| 73565 KNEE, WEIGHT BEARING, BILATERAL | |
| 73590 TIBIA & FIBULA, 2 VIEWS | |
| 73600 ANKLE, 2 VIEWS | |
| 73610 ANKLE, 3 VIEWS | |
| 73620 FOOT, 2 VIEWS | |
| 73630 FOOT, WEIGHT BEARING | |
| 73650 CALCANEUS, 2 VIEWS | |
| 73660 TOE(S) 2 OR MORE VIEWS | |
| 74000 ABDOMEN, SINGLE VIEW | |
| 74010 ABDOMEN AP, OBLIQUE, LAT | |
| 74018 ABDOMEN X-RAY, 1 VIEW | |
| 74019 ABDOMEN X-RAY, 2 VIEWS | |
| 74020 ABDOMEN AP, FLAT & ERECT | |
| 74021 ABDOMEN X-RAY, 3 OR MORE VIEWS | |
| 74022 ABDOMEN, FLAT, ERECT + CHEST | |
| 76080 EXAM OF FISTULA | |
| 77073 Bone length studies (orthoroentgenogram, scanogram) | |
| 77074 LIMITED BONE SURVEY | 15 |
| 77075 Radiologic examination, osseous survey; | |
| 77077 JOINT SURVEY, SINGLE VIEW OF 2 OR MORE JOINTS | |
| COMPUTED TOMOGRAPHY ANGIOGRAPHY (CTA) | 650 |
| 70498 CTA NECK, W/CONTRAST, & W/O IF PERFORMED | |
| 71275 CT ANGIO CHEST INCLUDING IMAGE POSTPRO | |
| 73206 CTA UPPER EXTREMITY W & W/O | |
| 73706 CTA LOWER EXTREMITY W/O CONTRAST FOLL BY W/CONTRAST | |
| 75635 CT ANGIO ABDOMINAL AORTA/BILATERAL ILIFEMORAL ARTERIES W/CONTRAST, POST PRO | |
| 70496 70498 70471 CTA NEURO | |
| 74175 CTA, ABDOMEN/PELVIS W/O FOLL BY W/CONTRAST | 50 |
| 70496 CTA HEAD | |
| 72191 CTA PELVIS | |
| 74174 CTA ABDOMEN AND PELVIS | |
| 75574 CORONARY CTA | |
| COMPUTED TOMOGRAPHY (CT) | 1750 |
| CT Abd & Pelvis exams | 850 |
| CT ABD & PELV 1/>REGNS | 10 |
| 70450 CT HEAD W/O CONT (SINGLE PHASE) | |
| 70460 CT HEAD W/IV CONT | |
| 70470 CT HEAD W&WO CONT | |
| 70480 CT TEMP BONE/IAC W/O CON (AXIAL) | |
| 70481 CT ORBIT SELLA POSTERIOR FOSSA/TEMP BO | |
| 70482 CT, orbit, sella, or posterior fossa or outer, middle, or inner ear | |
| 70486 CT SINUS W/O CONTRAST/ CT MAXILLOFACIAL W/O CONTRAST | |
| 70487 CT SINUS W/CONTRAST/ CT MAXILLOFACIAL W/CONT | |
| 70490 CT NECK SOFT TISSUE W/O CONT (SINGLE PHASE) | |
| 70491 CT NECK SOFT TISSUE W/CONT | |
| 70492 CT NECK SOFT TISSUE W/O FOLLOWED W/CONTRAST (MULTI PHASE) | |
| 71250 CT CHEST W/O CONTRAST (SINGLE PHASE) | |
| 71260 CT CHEST W/CONTRAST | |
| 71270 CT CHEST W/O AND W/ CONTRAST (MULTI PHASE) | |
| 71271 CT Low Dose Cancer Screening & CT Thorax | 10 |
| 72125 CT CERVICAL SPINE W/O CONTRAST (SINGLE PHASE) | |
| 72126 CT CERVICAL SPINE W/ CONTRAST | |
| 72127 CT CERVICAL SPINE W/O FOLLOWED W/CONTRAST (MULTI PHASE) | |
| 72128 CT THORACIC SPINE W/O CONT (SINGLE PHASE) | |
| 72129 CT THORACIC SPINE W/CONT | |
| 72130 CT THORACIC SPINE W/O FOLLOWED W/CONTRAST (MULTI PHASE) | |
| 72131 CT LUMBAR SPINE W/O CONT (SINGLE PHASE) | |
| 72132 CT LUMBAR SPINE W/CONTRAST | |
| 72133 CT LUMBAR SPINE W/O FOLLOWED W/CONTRAST (MULTI PHASE) | |
| 72192 CT PELVIS W/O CONT (SINGLE PHASE) | |
| 72193 CT PELVIS W/CONT | |
| 72194 CT PELVIS W/O FOLLOWED W/CONTRAST (MULTI PHASE) | |
| 73200 CT UPPER EXTREMITY W/O CONT (SINGLE PHASE) | |
| 73201 CT UPPER EXTREMITY W/CONT (MULTI PHASE) | |
| 73700 CT LOWER EXTREMITY W/O CONT (SINGLE PHASE) | |
| 73701 CT LOWER EXTREMITY W/CONT (MULTI PHASE) | |
| 73702 CT LOWER EXTREMITY W & W/O CONTRAST (MULTI PHASE) | |
| 74150 CT ABDOMEN W/O CONTRAST (SINGLE PHASE) | |
| 74160 CT ABDOMEN W/CONTRAST | |
| 74170 CT ABDOMEN W/O FOLLOWED W/CONTRAST (MULTI PHASE) | |
| 74176 CT ABOMEN/PELVIS WO CONTRAST (SINGLE PHASE) | |
| 71250 74150 CT CHEST/ABDOMEN/PELVIS WO CONT (SINGLE PHASE) | |
| 71260 74177 CT CHEST/ABDOMEN/PELVIS WO & W CONTRAST (MULTI PHASE) | |
| 75572 CT CARDIAC CORONARY OR NON CORONARY | |
| 75571 CT CALCIUM SCORING | |
| 77572 CT CARDIAC, HEART WITH | 10 |
| 77573 COMPUTER TOMOGRAPHY HEART WITH | 10 |
| 70488 CT MAXILLOFACIAL AREA WITHOUT AND WITH CONTRAST | |
| 73202 CT UPPER EXTREMITY WITHOUT AND WITH CONTRAST | |
| 74177 CT ABDOMEN AND PELVIS WITH CONTRAST | |
| 74178 CT ABDOMEN AND PELVIS WITHOUT AND WITH CONTRAST | |
| 75573 CARDIAC CT, CONGENITAL HEART DISEASE | |
| ULTRASOUND (US) | 50 |
| US Head & Neck (thyroid) | 10 |
| US Arterial Duplex | 10 |
| 76536 UL HEAD & NECK, THYROID/PARATHYROID/PAROTID | |
| 76604 UL CHEST | |
| 76700 UL ABDOMEN COMPLETE | |
| 76705 UL ABDOMEN LIMITED (BILE DUCTS/GB/LIVER/PANCREAS/SPLEEN) | |
| 76706 UL AAA ULTRASOUND, ABDOMINAL AORTA, SCREENING | |
| 76770 US complete retroperitoneal ultrasound, including kidneys, abdominal aorta, & urinary bladder | |
| 76775 UL LIMITED, AORTA or NODES | |
| 76830 UL TRANSVAGINAL | |
| 76856 UL PELVIC COMPLETE (NONOBSTETRIC) | |
| 76857 UL PELVIC LIMITED (NONOBSTETRIC) | |
| 76870 US SCROTUM | |
| 76881 UL COMPLETE, EXT/AXILLA/GROIN, JT/SOFT TISSUE/MUSCLE/TENDON | |
| 76882 UL LIMITED, EXT/AXILLA/GROIN, JT/SOFT TISSUE/MUSCLE/TENDON | |
| 76870 93975 US SCROTUM | |
| 76856 76830 93975 UL PELVIC COMPLETE W/TRANSVAGINAL | |
| 76857 76830 UL PELVIC LIMITED W/TRANSVAGINAL | |
| 76857 51798 UL POST VOID RESIDUAL | |
| 76700 51798 93976 UL KIDNEY TRANSPLANT PROTOCOL | |
| VASCULAR ULTRASOUND (US) | |
| 93975 UL VASCULAR, ABDOMEN, PELVIC, & SCROTAL | |
| 93976 UL ABDOMEN VASCULAR, LIMITED | |
| 76700 93975 UL ABDOMEN COMPLETE W/VASCULAR | |
| 76705 93975 UL Lover Transplant w Vascular | |
| 76776 51798 UL TRANSPLANTED KIDNEY W/VASCULAR & PVR | |
| 76700 51798 93976 UL Kidney Transplant Protocol | |
| MAGNETIC RESONANCE IMAGING (MRI) | 100 |
| MR Abdomen Exams | 25 |
| MR Prostate | 15 |
| 75557, 75559, 75561 MRI Cardiac-cpt code | 10 |
| 70551 70553 72141 72146 72148 MRI NEURO & SPINE | |
| 70540 MRI ORBIT, FACE AND/OR NECK(SOFT TISSUE) WO | |
| 70542 MRI ORBIT, FACE AND/OR NECK WITH CONTRAST | |
| 70543 MRI FACE/NECK/ORBIT W/O AND W/CONTRAST | |
| 70544 MRA HEAD WO CONTRAST | |
| 70547 MRA NECK WO CONTRAST | |
| 70548 MRA NECK, WITH CONTRAST | |
| 70549 MRA NECK W/OUT FOLLOWED W CONTRAST | |
| 70551 MRI BRAIN W/O CONTRAST | |
| 70552 MRI HEAD/BRAIN AND/OR BRAIN STEM WITH CONTRAST | |
| 70553 MRI HEAD/BRAIN AND/OR BRAIN STEM WO AND WITH CONTRAST | |
| 72141 MRI SPINE, CERVICAL W/O CONTRAST | |
| 72146 MRI SPINE, THORACIC W/O CONTRAST | |
| 72147 MRI T/SPINE W/CONTRAST | |
| 72148 MRI SPINE, LUMBAR W/O CONTRAST | |
| 72149 MRI SPINE, LUMBAR W CONTRAST | |
| 72156 MRI SPINE, CERVICAL W/O FOLLOWED BY CONTRAST | |
| 72157 MRI SPINE, THORACIC W/O FOLLOWED BY CONTRAST | |
| 72158 MRI SPINE, LUMBAR W/O FOLLOWED BY CONTRAST | |
| 72195 MRI PELVIS WITHOUT CONTRAST | |
| 73218 MRI UPPER EXTREMITY W/O CONTRAST (NO JOINTS) | |
| 73220 MRI UPPER EXTREMITY W AND W/O CONTRAST | |
| 73221 MRI UPPER EXTREMITY W/O CONTRAST (JOINTS) | |
| 73223 MRI UPPER EXTREMITY W/O AND W/CONTRAST (INCLUDE JOINTS) | |
| 73225 MRA UPPER EXTREMITY | |
| 73725 MRA LOWER EXTREMITY | |
| 73718 MRI LOWER EXTREMITY W/O CONTRAST (NO JOINTS) | |
| 73720 MRI LOWER EXTREMITY W AND W/O CONTRAST(NO JOINTS) | |
| 73721 MRI LOWER EXTREMITY W/O CONTRAST (JOINTS) | |
| 74181 MRI ABDOMEN W/O CONTRAST | |
| 74182 MRI ABDOMEN W/CONTRAST | |
| 74183 MRI ABDOMEN W/O AND W CONTRAST | |
| 74185 MRA ABDOMEN W AND WO CONTRACT | |
| 74185 73725 MRA RUNOFF (BODY AND EXTRMITY) | |
| 75561 MR CARDIAC | |
| 76377, to be added to all MRA studies | |
| 70336 MRI TEMPOROMANDIBULAR JOINT (TMJ) | |
| 70545 MRA HEAD WITH CONTRAST | |
| 70546 MRA HEAD WITHOUT AND WITH CONTRAST | |
| 72142 MRI SPINE, CERVICAL WITH CONTRAST | |
| 72196 MRI PELVIS WITH CONTRAST | |
| 72197 MRI PELVIS WITHOUT AND WITH CONTRAST | |
| 73219 MRI UPPER EXTREMITY, NON-JOINT, WITH CONTRAST | |
| 73222 MRI UPPER EXTREMITY JOINT WITH CONTRAST | |
| 73719 MRI LOWER EXTREMITY, NON-JOINT, WITH CONTRAST | |
| 73722 MRI LOWER EXTREMITY JOINT WITH CONTRAST | |
| 73723 MRI LOWER EXTREMITY JOINT WITHOUT AND WITH CONTRAST | |
| 71550 MRI CHEST WITHOUT CONTRAST | |
| 71551 MRI CHEST WITH CONTRAST | |
| 71552 MRI CHEST WITHOUT AND WITH CONTRAST | |
| 75563 CARDIAC MRI WITH STRESS IMAGING | |
| 72159 MRA SPINAL CANAL AND CONTENTS | |
| NUCLEAR MEDICINE | 25 |
| 78226 A9537 J2270 J3590 Hepatobiliary Imaging, GB, w/o Pharm | |
| 78227 A9537 J2270 J3590 Hepatobiliary Imaging, GB, with Pharm Intervention | |
| 78278 A9560 78999 GI Bleed Scan (Acute GI Blood Loss) | |
| 78582 A9567 A9540 V/Q (R/O PE) | |
| 78707 A9562 Renal FX W/Out Lasix | |
| 78708 A9562 J1941 (x2) Renal Function W/Lasix |
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