BID SCHEDULE ATTACHMENT 1.xlsx
XLSX spreadsheet 15 KB Posted
- Solicitation number
- 75H70523R00002
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| File | Type | Posted |
|---|---|---|
| 0002 Amendment.pdf | ||
| pg 2.pdf | ||
| 0001 Amendment.pdf | ||
| Instruction to Offerors Letter.pdf | ||
| 75H70523R00002 RFP Package.pdf |
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Text version
CT
| ATTACHMENT 1 - CT Fee Schedule (SEE TAB BELOW) | ||||
| BASE YEAR 2/1/2023 - 1/31/2024 | ** YOU MUST INCLUDE OPTION YEAR PRICING AS WELL** | |||
| CPT | DESCRIPTION | TYPE | COST | |
| Q9967 | IV CONTRAST KIT | CT | PER KIT | |
| Q9963 | ORAL CONTRAST | CT | PER KIT | |
| 76377 | CT 3D RECONSTR AT W/STATION POST PROCESS | CT | ||
| 74178 | CT ABD/PELVIS W AND W/O CONTRAST | CT | ||
| 74176 | CT ABD/PELVIS W/O CONTRAST | CT | ||
| 74177 | CT ABD/PELVIS WITH CONTRAST | CT | ||
| 74160 | CT ABDOMEN W/CONTRAST | CT | ||
| 74170 | CT ABDOMEN W/O AND W/CONTRAST | CT | ||
| 74150 | CT ABDOMEN W/O CONTRAST | CT | ||
| 72126 | CT CERVICAL SPINE, W/CONTRAST | CT | ||
| 72127 | CT CERVICAL SPINE, W/O AND W/CONTRAST | CT | ||
| 72125 | CT CERVICAL SPINE, W/O CONTRAST | CT | ||
| 71260 | CT CHEST W/CONTRAST | CT | ||
| 71270 | CT CHEST W/O AND W/CONTRAST | CT | ||
| 71250 | CT CHEST W/O CONTRAST | CT | ||
| 74174 | CT CTA ABD/PELVIS W/POST PROCESSING | CT | ||
| 74175 | CT CTA ABDOMEN W/O AND W/CONTRAST POST | CT | ||
| 71275 | CT CTA CHEST W/O AND W/CONTRAST POST PR | CT | ||
| 70496 | CT CTA HEAD W/O AND W/CONTRAST POST PR | CT | ||
| 73706 | CT CTA L/EXTREMITY W/O AND W/CONTRAST | CT | ||
| 70498 | CT CTA NECK W/O AND W/CONTRAST POST PR | CT | ||
| 72191 | CT CTA PELVIS W/O AND W/CONTRAST POST PR | CT | ||
| 73206 | CT CTA U/EXTREMITY W/O AND W/CONTRAST | CT | ||
| 73201 | CT ELBOW/FOREARM LT W/CONTRAST | CT | ||
| 73202 | CT ELBOW/FOREARM LT W/O AND W/CONTRAST | CT | ||
| 73200 | CT ELBOW/FOREARM LT W/O CONTRAST | CT | ||
| 73201 | CT ELBOW/FOREARM RT W/CONTRAST | CT | ||
| 73202 | CT ELBOW/FOREARM RT W/O AND W/CONTRAST | CT | ||
| 73200 | CT ELBOW/FOREARM RT W/O CONTRAST | CT | ||
| 73701 | CT FEMUR LT W/CONTRAST | CT | ||
| 73702 | CT FEMUR LT W/O AND W/CONTRAST | CT | ||
| 73700 | CT FEMUR LT W/O CONTRAST | CT | ||
| 73701 | CT FEMUR RT W/CONTRAST | CT | ||
| 73702 | CT FEMUR RT W/O AND W/CONTRAST | CT | ||
| 73700 | CT FEMUR RT W/O CONTRAST | CT | ||
| 73701 | CT FOOT/ANKLE LT W/CONTRAST | CT | ||
| 73702 | CT FOOT/ANKLE LT W/O AND W/CONTRAST | CT | ||
| 73700 | CT FOOT/ANKLE LT W/O CONTRAST | CT | ||
| 73701 | CT FOOT/ANKLE RT W/CONTRAST | CT | ||
| 73702 | CT FOOT/ANKLE RT W/O AND W/CONTRAST | CT | ||
| 73700 | CT FOOT/ANKLE RT W/O CONTRAST | CT | ||
| 73201 | CT HAND/WRIST LT W/CONTRAST | CT | ||
| 73202 | CT HAND/WRIST LT W/O AND W/CONTRAST | CT | ||
| 73200 | CT HAND/WRIST LT W/O CONTRAST | CT | ||
| 73201 | CT HAND/WRIST RT W/CONTRAST | CT | ||
| 73202 | CT HAND/WRIST RT W/O AND W/CONTRAST | CT | ||
| 73200 | CT HAND/WRIST RT W/O CONTRAST | CT | ||
| 70460 | CT HEAD OR BRAIN W/CONTRAST | CT | ||
| 70470 | CT HEAD OR BRAIN W/O AND W CONTRAST | CT | ||
| 70450 | CT HEAD OR BRAIN W/O CONTRAST | CT | ||
| 73701 | CT HIP LT W/CONTRAST | CT | ||
| 73702 | CT HIP LT W/O AND W/CONTRAST | CT | ||
| 73700 | CT HIP LT W/O CONTRAST | CT | ||
| 73701 | CT HIP RT W/CONTRAST | CT | ||
| 73702 | CT HIP RT W/O AND W/CONTRAST | CT | ||
| 73700 | CT HIP RT W/O CONTRAST | CT | ||
| 73201 | CT HUMERUS LT W/CONTRAST | CT | ||
| 73202 | CT HUMERUS LT W/O AND W/CONTRAST | CT | ||
| 73200 | CT HUMERUS LT W/O CONTRAST | CT | ||
| 73201 | CT HUMERUS RT W/CONTRAST | CT | ||
| 73202 | CT HUMERUS RT W/O AND W/CONTRAST | CT | ||
| 73200 | CT HUMERUS RT W/O CONTRAST | CT | ||
| 73700 | CT KNEE TIB/FIB RT W/O CONTRAST | CT | ||
| 73701 | CT KNEE TIB/FIB LT W/CONTRAST | CT | ||
| 73702 | CT KNEE TIB/FIB LT W/O AND W/CONTRAST | CT | ||
| 73700 | CT KNEE TIB/FIB LT W/O CONTRAST | CT | ||
| 73701 | CT KNEE TIB/FIB RT W/CONTRAST | CT | ||
| 73702 | CT KNEE TIB/FIB RT W/O AND W/CONTRAST | CT | ||
| 72132 | CT LUMBAR SPINE W/CONTRAST | CT | ||
| 72133 | CT LUMBAR SPINE W/O AND W/CONTRAST | CT | ||
| 72131 | CT LUMBAR SPINE W/O CONTRAST | CT | ||
| 70487 | CT MAXILLOFACIAL W/CONTRAST | CT | ||
| 70488 | CT MAXILLOFACIAL W/O AND W/CONTRAST | CT | ||
| 70486 | CT MAXILLOFACIAL W/O CONTRAST | CT | ||
| 77012 | CT NEEDLE PLACEMENT | CT | ||
| 71260 | CT PE STUDY | CT | ||
| 72193 | CT PELVIS W/CONTRAST | CT | ||
| 72192 | CT PELVIS W/O CONTRAST | CT | ||
| 72194 | CT PELVIS W/O AND W/CONTRAST | CT | ||
| 70482 | CT SELLA, ORBIT, INNER EAR W/O AND W/CON | CT | ||
| 70481 | CT SELLA, ORBIT, INNER EAR, W/CONTRAST | CT | ||
| 70480 | CT SELLA, ORBIT, INNER EAR, W/O CONTRAST | CT | ||
| 73201 | CT SHOULDER LT W/CONTRAST | CT | ||
| 73202 | CT SHOULDER LT W/O AND W/CONTRAST | CT | ||
| 73200 | CT SHOULDER LT W/O CONTRAST | CT | ||
| 73201 | CT SHOULDER RT W/CONTRAST | CT | ||
| 73202 | CT SHOULDER RT W/O AND W/CONTRAST | CT | ||
| 73200 | CT SHOULDER RT W/O CONTRAST | CT | ||
| 70491 | CT SOFT TISSUE NECK, W/CONTRAST | CT | ||
| 70492 | CT SOFT TISSUE NECK, W/O AND W/ CONTRAST | CT | ||
| 70490 | CT SOFT TISSUE NECK, W/O CONTRAST | CT | ||
| 74176 | CT STONE PROTOCOL | CT | ||
| 72129 | CT THORACIC SPINE W/CONTRAST | CT | ||
| 72130 | CT THORACIC SPINE W/O AND W/CONTRAST | CT | ||
| 72128 | CT THORACIC SPINE W/O CONTRAST | CT | ||
| 74170 | CT UROGRAM | CT |
MRI
| ATTACHMENT 1 MRI Fee Schedule (SEE TAB BELOW) | ||||
| BASE YEAR: 2/1/2023-1/31/2024 | ||||
| CPT CODE | DESCRIPTION | TYPE | CHARGE | |
| A9579 | GADOLINIUM CONTRAST & KIT | MRI | PER UNIT | **This could be more than one per patient weight |
| 70336 | TEMPOROMANDIBULAR JOINT | MRI | ||
| 70540 | ORBIT, FACE, AND NECK W/O CONTRAST | MRI | ||
| 70542 | WITH CONTRAST | MRI | ||
| 70543 | WITH AND WITHOUT CONTRAST | MRI | ||
| 70544 | ANGIOGRAPHY, HEAD W/O CONTRAST | MRI | ||
| 70545 | WITH CONTRAST | MRI | ||
| 70546 | WITH AND WITHOUT CONTRAST | MRI | ||
| 70547 | ANGIOGRAPHY, NECK W/O CONTRAST | MRI | ||
| 70548 | WITH CONTRAST | MRI | ||
| 70549 | WITH AND WITHOUT CONTRAST | MRI | ||
| 70551 | BRAIN (including brain stem) W/O CONTRAST | MRI | ||
| 70552 | WITH CONTRAST | MRI | ||
| 70553 | WITH AND WITHOUT CONTRAST | MRI | ||
| 71550 | CHEST (for evaluation of hilar and mediastinal lymphadenopathy) W/O CONTRAST | MRI | ||
| 71551 | WITH CONTRAST | MRI | ||
| 71552 | WITH AND WITHOUT CONTRAST | MRI | ||
| 71555 | ANGIOGRAPHY, CHEST (excluding myocardium) WITH OR W/O CONTRAST | MRI | ||
| 72141 | SPINAL CANAL & CONTENTS, CERVICAL W/O CONTRAST | MRI | ||
| 72142 | WITH CONTRAST | MRI | ||
| 72146 | SPINAL CANAL & CONTENTS, THORACIC W/O CONTRAST | MRI | ||
| 72147 | WITH CONTRAST | MRI | ||
| 72148 | SPINAL CANAL & CONTENTS, LUMBAR W/O CONTRAST | MRI | ||
| 72149 | WITH CONTRAST | MRI | ||
| 72156 | SPINAL CANAL & CONTENTS, CERVICAL W/O CONTRAST & WITH CONTRAST | MRI | ||
| 72157 | SPINAL CANAL & CONTENTS, THORACIC W/O CONTRAST & WITH CONTRAST | MRI | ||
| 72158 | SPINAL CANAL & CONTENTS, LUMBAR W/O CONTRAST & WITH CONTRAST | MRI | ||
| 72159 | ANGIOGRAPHY, SPINAL CANAL & CONTENTS WITH OR W/O CONTRAST | MRI | ||
| 72195 | PELVIS W/O CONTRAST | MRI | ||
| 72196 | WITH CONTRAST | MRI | ||
| 72197 | WITH AND WITHOUT CONTRAST | MRI | ||
| 72198 | ANGIOGRAPHY, PELVIS WITH OR WITHOUT CONTRAST | MRI | ||
| 73218 | UPPER EXTREMITY, OTHER THAN JOINT W/O CONTRAST | MRI | ||
| 73219 | WITH CONTRAST | MRI | ||
| 73220 | WITH AND WITHOUT CONTRAST | MRI | ||
| 73221 | ANY JOINT OF UPPER EXTREMITY W/O CONTRAST | MRI | ||
| 73222 | WITH CONTRAST | MRI | ||
| 73223 | WITH AND WITHOUT CONTRAST | MRI | ||
| 73225 | ANGIOGRAPHY, UPPER EXTREMITY WITH OR W/O CONTRAST | MRI | ||
| 73718 | LOWER EXTREMITY OTHER THAN JOINT W/O CONTRAST | MRI | ||
| 73719 | WITH CONTRAST | MRI | ||
| 73720 | WITH AND WITHOUT CONTRAST | MRI | ||
| 73721 | ANY JOINT OF LOWER EXTREMITY W/O CONTRAST | MRI | ||
| 73722 | WITH CONTRAST | MRI | ||
| 73723 | WITH AND WITHOUT CONTRAST | MRI | ||
| 73725 | ANGIOGRAPHY, LOWER EXTREMITY WITH OR W/O CONTRAST | MRI | ||
| 74181 | ABDOMEN W/O CONTRAST | MRI | ||
| 74182 | WITH CONTRAST | MRI | ||
| 74183 | WITH AND WITHOUT CONTRAST | MRI | ||
| 74185 | ANGIOGRAPHY, ABDOMEN WITH OR W/O CONTRAST | MRI | ||
| 75552 | CARDIAC FOR MORPHOLOGY W/O CONTRAST | MRI | ||
| 75553 | WITH CONTRAST | MRI | ||
| 75554 | CARDIAC FOR FUNCTION, WITH OR W/O MORPHOLOGY, COMPLETE STUDY | MRI | ||
| 75555 | LIMITED STUDY | MRI | ||
| 75556 | CARDIAC FOR VELOCITY FLOW MAPPING | MRI | ||
| 76093 | BREAST W/O AND/OR WITH CONTRAST, UNILATERAL | MRI | ||
| 76094 | BREAST W/O AND/OR WITH CONTRAST, BILATERAL | MRI | ||
| 76390 | SPECTROSCOPY | MRI | ||
| 76393 | GUIDANCE FOR NEEDLE PLACEMENT (For biopsy, needle aspiration, injection, or placement of localization device) RADIOLOGICAL SUPERVISION AND INTERPRETATION | MRI | ||
| 76400 | BONE MARROW BLOOD SUPPLY | MRI |
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