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PRICE SHEET
Use the following worksheet or submit an equivalent price sheet for the items indicated (contracted prices must clearly correlate with each orderable item as invoiced). The indicated estimated annual quantities are based on historical deliveries that will vary based on actual patient-care requirements. Zero-quantity items may be ordered in low quantity: enter price to indicate availability or indicate N/A or unavailable.
Note that there are three known pricing strategies: 1) the preferred is a single unit price for a reasonable range of activity, 2) a fixed price per unit of activity, and 3) a combination where there is a fixed initial price for an activity up to a designated value followed by a fixed price per unit of additional activity.
Be sure to indicate which strategy is used for each item (recommend grouping separately into the three groups or into any other group that is clearly defined.
The organization below is only suggested: modify according to the contractor’s pricing strategy. Use the following designated quantities. Indicate price where quantity is not indicated if the product is available just in case a requirement develops during the contract period.
If the suggested group below is incorrect, move the radiopharmaceutical to the correct group.
Excel spreadsheet is included but contractor is responsible for the calculations.
Somewhere indicate items available for 1-hour delivery, special order, etc.
1) Radiopharmaceuticals priced based on fixed unit dose price
| Item |
| "A" Estimated Base Qty UD |
Adjusted Qty "C" Contract Price A*B*C= Cost
| C-14 Carbon-14 urea kit (including H Pylori Breath Test Analysis) |
| 3 |
F-18 FDG Fludeoxyglucose UD
| I-123 (Sodium Iodide I-123 Capsule) (0.2 mCi capsule) |
| 10 |
I-123 Iobenguane Sulfate; I-123 MIBG (Adreview) UD
In-111 Capromab Pendetide (Prostascint) UD
| In-111 Pentetreotide (Octreoscan®) UD |
| 6 |
| Sm-153 Lexidronam (Quadramet®) ~100 mCi UD |
| 1 |
| Sr-89 Strontium Chloride UD |
| 1 |
Tc99m Bicisate Dihydrochloride (Neurolite®) UD
Tc99m Disofenin UD
| Tc99m DTPA (Pentetate) [15 mCi for injection] UD |
| 20 |
| Tc99m DTPA ~45 mCi Pulmonary [for aerosol] UD |
| 30 |
Tc99m Ceretec (Exametazime aka HMPAO) UD {brain study}
Tc99m HDP (Oxidronate) UD
| Tc99m MAA (Macroaggregated Albumin) UD |
| 30 |
| Tc99m MDP (Medronate) UD |
| 220 |
| Tc99m Mebrofenin (Choletec) UD |
| 45 |
| Tc99m Mertiatide (MAG3) UD |
| 15 |
Tc99m PYP (Pyrophosphate) UD
Tc99m Sestamibi-Generic UD
Tc99m Sestamibi as Cardiolite UD
| Tc99m Tetrofosmin (Myoview) UD |
| 1250 |
Lidocaine dilution for sulfur colloid intradermal injection
| Tc99m Sulfur Colloid Filtered UD (~0.5 mCi per UD) |
| 8 |
| Tc99m Sulfur Colloid UD (~1 mCi per UD) (oral) |
| 25 |
| Tc99m Sulfur Colloid UD (~10 mCi per UD) |
| 4 |
| Tl-201 (Thallous Chloride) UD (1 mCi per UD) |
| 2 |
| Tl-201 (Thallous Chloride) UD (4 mCi per UD) |
| 15 |
| Sn-PYP (Pyrophosphate) VIAL for Labeling Red Blood Cells (per vial) |
| 10 |
| UltraTag® VIAL for Labeling Red Blood Cells (per vial) |
| 25 |
| Labeled WBC (autologous leukocytes) In-111 Oxine (Oxyquinoline) UD |
| 5 |
Labeled WBC (autologous leukocytes) In-111 Chloride (Tropolone) UD
Labeled WBC (autologous leukocytes) Tc99m Ceretec (Exametazime HMPAO) UD
Adenoscan (Adenosine) Single Use per # mg ordered
Adenoscan (Adenosine) 20 mL VIAL
Adenoscan (Adenosine) 30 mL VIAL
Captopril 50 mg tablet
Kinevac (Cholecystokinin - CCK) UD
Kinevac (Cholecystokinin - CCK) VIAL
Lexiscan™ (Regadenoson) UD
2.5 cc Lifetime Syringe Shield
3 cc Lifetime Syringe Shield
5 cc Lifetime Syringe Shield
10 cc Lifetime Syringe Shield
2) Radiopharmaceuticals priced based on fixed price per unit of activity (millicurie or microcurie)
Base Qty UD
Adjusted Qty "C" Contract Price A*B*C= Cost
| I-123 (Sodium Iodide I-123 Capsules) (4 mCi capsule) additional per mCi |
| 2 |
| Ga-67 (Gallium Citrate) (~0.080 mCi per UD) |
| 3 |
0.08
| Ga-67 (Gallium Citrate) (~6 mCi per UD) |
| 3 |
| Ga-67 (Gallium Citrate) (~9 mCi per UD) |
| 3 |
3) Radiopharmaceuticals priced based on Initial unit dose price (top line) and fixed price per each additional unit of activity (microcurie or millicurie)
Base Qty UD
Adjusted Qty "C" Contract Price A*B*C= Cost
| I-131 (Sodium Iodide Compounded Capsules) per first 6 mCi UD |
| 5 |
Additional cost for activity above base cost:
| I-131 (Sodium Iodide Compounded Capsules) per ~1-2 mCi capsule |
| 0 |
| I-131 (Sodium Iodide Compounded Capsules) per ~10-15 mCi capsule |
| 2 |
| I-131 (Sodium Iodide Compounded Capsules) per ~30 mCi capsule |
| 1 |
| I-131 (Sodium Iodide Compounded Capsules) per ~100 mCi capsule |
| 2 |
| Tc99m NaTc04 UD pre first UD (30 mCi) |
| 46 |
Additional cost for activity above base cost:
| TC99m NaTc04-QC; syringe (~10 mCi per UD) |
| 2 |
| Tc99m NaTc04 UD (~25-35 mCi) extra mCi |
| 40 |
| TC99m NaTc04-QC; VIAL (~250 mCi per vial) |
| 4 |
Totals
