Atch1_36C25522Q0099_CSS_SleepStudies_Price_Schedule.pdf
PDF 205 KB Posted
- Attached to
- Amendment A0001 On-Site Sleep Studies, Dole VAMC, Wichita Federal contract opportunity
- Solicitation number
- 22Q0099WISleepStudy
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amended Atch2_36C25522Q0099_CSS_SleepStudies_PWS.pdf | ||
| Amendment A0001.pdf | ||
| Atch5_36C25522Q0099_CSS_52.212-4_52.212-5_Related.pdf | ||
| Atch8_36C25522Q0099_CSS_QASP.pdf | ||
| RFQ_36C25522Q0099_CSS_SleepStudies.pdf | ||
| Atch4_36C25522Q0099_CSS_Addend_852.273-73.pdf | ||
| Atch2_36C25522Q0099_CSS_SleepStudies_PWS.pdf | ||
| Atch7_36C25522Q0099_CSS_PastPerfQuest(PPQ).pdf | ||
| Atch9_36C25522Q0099_CSS_Immig_Cert.pdf | ||
| Atch6_36C25522Q0099_SecLange_6500.6_ApdxC.pdf | ||
| Atch3_36C25522Q0099_CSS_Addend_52.212-1.pdf |
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Text version
Combined Synopsis-Solicitation for Commercial Items Request for Quotation (RFQ) 36C25522Q0099
ATTACHMENT 1: PRICE SCHEDULE
BASE YEAR
LINE ITEM
NO.
DESCRIPTION OF
SUPPLIES/SERVICES
ESTIMATED
QUANTITY UNIT UNIT PRICE AMOUNT
1.00 Not Priced
On-Site Home Sleep Study Test (HSAT) – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study Contract Period: Base POP Begin: 02-01-2022 POP End: 01-31-2023
0001AA
600.00 EA $____________ $____________
CMS CPT 95800 – Home Sleep Study Test (HSAT) – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study – Completed and Scored.
0001AB
60.00 EA $____________ $____________
CMS CPT 95800-Inc – Incomplete/Failed HSAT – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study – Unable to Complete Scoring.
Daytime (Occasional/Rare) On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation 8:00 a.m. to 4:30 p.m.
0002AA
10.00 EA $_____________ $____________
Daytime (Occasional/Rare) CMS CPT 95805 – On-Site Sleep Study – Clinical Services – MSLT/MWT – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
8:00 a.m. to 4:30 p.m.
0002AB
3.00 EA $_____________ $____________
Daytime (Occasional/Rare) CMS CPT 95805-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete Scoring.
Nighttime On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation 4:30 p.m. to 8:00 a.m.
0003AA
150.00 EA $_____________ $____________
Nighttime CMS CPT 95808 – On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
0003AB
50.00 EA $_____________ $____________
Nighttime CMS CPT 95808-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – CPAP Sleep Study
– Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
0003AC
100.00 EA $_____________ $____________
Nighttime CMS CPT 95810 – On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
0003AD
55.00 EA $_____________ $____________
Nighttime CMS CPT 95810-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
0003AE
75.00 EA $_____________ $____________
Nighttime CMS CPT 95811 – On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
0003AF
Nighttime CMS CPT 95811-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
Estimated Total Quantity – 1,113 studies, of the quantity, estimated 935 completed studies and estimated 178 incomplete/failed studies this period of performance.
BASE YEAR ESTIMATED TOTAL $____________
OPTION YEAR ONE (1)
LINE ITEM
NO.
DESCRIPTION OF
SUPPLIES/SERVICES
ESTIMATED
On-Site Home Sleep Study Test (HSAT) – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study Contract Period: Base POP Begin: 02-01-2023 POP End: 01-31-2024
1001AA
1001AB
CMS CPT 95800-Inc – Incomplete/Failed HSAT – Clinical Services – Receive VA-owned HSAT Equipment, Score
Daytime (Occasional/Rare) On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation 8:00 a.m. to 4:30 p.m.
1002AA
Daytime (Occasional/Rare) CMS CPT 95805 – On-Site Sleep Study – Clinical Services – MSLT/MWT – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
1002AB
Daytime (Occasional/Rare) CMS CPT 95805-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete Scoring.
Nighttime On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation
1003AA
Nighttime CMS CPT 95808 – On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
1003AB
Nighttime CMS CPT 95808-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – CPAP Sleep Study
– Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
1003AC
Nighttime CMS CPT 95810 – On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
1003AD
Nighttime CMS CPT 95810-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
1003AE
Nighttime CMS CPT 95811 – On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
1003AF
Nighttime CMS CPT 95811-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
Estimated Total Quantity – 1,113 studies, of the quantity, estimated 935 completed studies and estimated
OPTION YEAR 1 ESTIMATED TOTAL $____________
OPTION YEAR TWO (2)
NO.
DESCRIPTION OF
SUPPLIES/SERVICES
ESTIMATED
On-Site Home Sleep Study Test (HSAT) – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study Contract Period: Base POP Begin: 02-01-2024 POP End: 01-31-2025
2001AA
2001AB
CMS CPT 95800-Inc – Incomplete/Failed HSAT – Clinical Services – Receive VA-owned HSAT Equipment, Score
Daytime (Occasional/Rare) On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation
8:00 a.m. to 4:30 p.m.
2002AA
Daytime (Occasional/Rare) CMS CPT 95805 – On-Site Sleep Study – Clinical Services – MSLT/MWT – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
2002AB
Daytime (Occasional/Rare) CMS CPT 95805-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete Scoring.
Nighttime On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation
2003AA
Nighttime CMS CPT 95808 – On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
2003AB
Nighttime CMS CPT 95808-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – CPAP Sleep Study
– Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
2003AC
Nighttime CMS CPT 95810 – On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
2003AD
Nighttime CMS CPT 95810-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
2003AE
Nighttime CMS CPT 95811 – On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
2003AF
Nighttime CMS CPT 95811-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
Estimated Total Quantity – 1,113 studies, of the quantity, estimated 935 completed studies and estimated
OPTION YEAR 2 ESTIMATED TOTAL $____________
OPTION YEAR THREE (3)
LINE ITEM
NO.
DESCRIPTION OF
SUPPLIES/SERVICES
ESTIMATED
On-Site Home Sleep Study Test (HSAT) – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study Contract Period: Base POP Begin: 02-01-2025 POP End: 01-31-2026
3001AA
3001AB
CMS CPT 95800-Inc – Incomplete/Failed HSAT – Clinical Services – Receive VA-owned HSAT Equipment, Score
Daytime (Occasional/Rare) On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation 8:00 a.m. to 4:30 p.m.
3002AA
Daytime (Occasional/Rare) CMS CPT 95805 – On-Site Sleep Study – Clinical Services – MSLT/MWT – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
3002AB
Daytime (Occasional/Rare) CMS CPT 95805-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete Scoring.
Nighttime On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation
3003AA
Nighttime CMS CPT 95808 – On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
3003AB
Nighttime CMS CPT 95808-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – CPAP Sleep Study
– Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
3003AC
Nighttime CMS CPT 95810 – On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
3003AD
Nighttime CMS CPT 95810-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
3003AE
Nighttime CMS CPT 95811 – On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
3003AF
Nighttime CMS CPT 95811-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
Estimated Total Quantity – 1,113 studies, of the quantity, estimated 935 completed studies and estimated
OPTION YEAR 3 ESTIMATED TOTAL $____________
OPTION YEAR FOUR (4)
NO.
DESCRIPTION OF
SUPPLIES/SERVICES
ESTIMATED
On-Site Home Sleep Study Test (HSAT) – Clinical Services – Receive VA-owned HSAT Equipment, Score and Document HSAT Sleep Study Contract Period: Base POP Begin: 02-01-2026 POP End: 01-31-2027
4001AA
4001AB
CMS CPT 95800-Inc – Incomplete/Failed HSAT – Clinical Services – Receive VA-owned HSAT Equipment, Score
Daytime (Occasional/Rare) On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation 8:00 a.m. to 4:30 p.m.
4002AA
Daytime (Occasional/Rare) CMS CPT 95805 – On-Site Sleep Study – Clinical Services – MSLT/MWT – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
4002AB
Daytime (Occasional/Rare) CMS CPT 95805-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Multiple Sleep Latency Test/Maintenance of Wakefulness Testing (MSLT/MWT) – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete Scoring.
Nighttime On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation
4003AA
Nighttime CMS CPT 95808 – On-Site Sleep Study – Clinical Services – CPAP Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
4003AB
Nighttime CMS CPT 95808-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – CPAP Sleep Study
– Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
4003AC
Nighttime CMS CPT 95810 – On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
4003AD
Nighttime CMS CPT 95810-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Full Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
4003AE
Nighttime CMS CPT 95811 – On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Completed and Scored.
4003AF
Nighttime CMS CPT 95811-Inc – Incomplete/Failed On-Site Sleep Study – Clinical Services – Split Night Sleep Study – Schedule, Manage and Monitor, Scoring and Documentation – Unable to Complete and Score.
Estimated Total Quantity – 1,113 studies, of the quantity, estimated 935 completed studies and estimated
OPTION YEAR 4 ESTIMATED TOTAL $____________
Estimated Total Quantity – All five (5) periods of performance – estimated 5,565 studies - estimated 4,675 completed studies and estimated 890 incomplete/failed studies.
ESTIMATED GRAND TOTAL ALL PERIODS OF PERFORMANCE $_________________
FAR 52.217-9 (Option Years 1, 2, 3 and 4) may be exercised at the sole discretion of the Government.
FAR 52.217-8 may be exercised at the sole discretion of the Government.
ATTACHMENT 1: PRICE SCHEDULE
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