SCHEDULE.xlsx

XLSX spreadsheet 43 KB Posted Sep 11, 2021

Attached to: Q523-- Laser and Technician Service
Solicitation number: 36C26121Q0530
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21

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File	Type	Posted
Q_A Document 9-30-2021.docx	DOCX document	Sep 30, 2021
36C26121Q0530 0002.docx	DOCX document	Sep 30, 2021
36C26121Q0530 0001.docx	DOCX document	Sep 27, 2021
36C26121Q0530_2.docx	DOCX document	Sep 11, 2021
WD 2015-5631 Sacramento County Revision 13 DOLR 8-3-21.pdf	PDF	Sep 11, 2021
QASP-PRI Laser tech Revised10-29-2020.docx	DOCX document	Sep 11, 2021
WD 2015-5623 Contra Costa County Revision 15 DOLR 7-21-21.pdf	PDF	Sep 11, 2021

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Item Information

Item Number

Description

Contract Period

Pop Begin

Pop End

Quantity

Unit of Measure

Unit Price

Amount

PRINCIPAL NAICS CODE

PRODUCT/SERVICE CODE

UNSPSC

SIC CODE

MANUFACTURER PART NUMBER (MPN)

NATIONAL STOCK NUMBER

LOCAL STOCK NUMBER

0001

GREENLIGHT XPS

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0001AA

Greenlight XPS Procedure

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0001AB

Greenlight XPS Moxy Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0001AC

BPH Cystoscope (if needed)

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0001AD

BPH Standby Fee

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002

HOLMIUM UROLOGY

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002AA

Holmium Urology Procedure

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002AB

200 Micron Reusable Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002AC

365 Micron Reusable Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002AD

550 Micron Reusable Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002AE

1000 Micron Reusable Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002AF

200 Micron Single-Use Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002AG

272 Micron Single-Use Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002AH

273 Micron Single-Use Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002AI

550 Micron Single-Use Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002AJ

1000 Micron Single-Use Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002AK

600um Dual SF Fiber

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0002AL

Standby Fee

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0003

KTP

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0003AA

KTP Procedure

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0003AB

400 Micron Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0003AC

600 Micron Fiber Single-Use

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0003AD

Aura 125 UM Accustat Filter

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0003AE

Aura 100 UM Accustat Filter

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0003AF

Additional for KTP Aura Laser

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0003AG

KTP Standby Fee

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0004

CO2 SURGICAL

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0004AA

CO2 Surgical Procedure

Base

11/1/21

10/31/22

4.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0004AB

Smoke Evaculator with Filter

Base

11/1/21

10/31/22

4.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0004AC

Sterile Tubing

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0004AD

Micromanipulator

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0004AE

Colposcope

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0004AF

Operative Laparoscope

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0004AG

Gyn Instrument

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0004AH

ET Tube

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0004AI

5000L Technology

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0004AJ

Hi Scan Pattern Generator

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0004AK

CO2 Surgical Standby Fee

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0005

CO2 OMNIGUIDE

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0005AA

CO2 Omniguide Procedure

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0005AB

Single-Use Otobeam M Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0005AC

Single-Use Otobeam S Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0005AD

Elevate Elite Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0005AE

BP-Robotic Fiber

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0005AF

Sterile Gas Filter

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0005AG

Instrument Set

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0005AH

CO2 Omniguide Standby Fee

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0006

SPECIALIZED EQUIPMENT

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0006AA

ESWL Table Procedure

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0006AB

Additional Charge for Bilateral Procedure

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0006AC

Additional Charge for Patients300-450 lbs

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0006AD

Standby for less than 72 hours

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0006AE

Cancellation Fee

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0007

CRYO - ENDOCARE (PROSTATE)

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0007AA

Cryo-Endocare for Prostate

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0007AB

Cryo Prostate 206 V Kit

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0007AC

Argon Gas Tank

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0007AD

Helium Gas Tank

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0007AE

Cryo 2.4mm V probe

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0007AF

Additional Temp Probe

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0007AG

Urethral Warming Catheter Kit

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0007AH

B&K Ultrasound Unit (Special Request)

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0008

CRYO - ENDOCARE (RENAL)

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0008AA

Cryo-Endocare for Renal

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0008AB

Renal Kit (includes two probes)

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0008AC

Additonal Renal Probe (choices include):

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0008AD

Renal Cryo Probe R1.7

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0008AE

Renal Cryo Probe R1.7L

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0008AF

Renal Cryo Probe R2.4

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0008AG

Renal Cryo Probe R2.4 Long

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0008AH

Renal Cryo Probe R3.8 Angled

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0008AI

Renal Cryo Probe R3.8 Long

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0008AJ

Cryo Standby Fee

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0009

OTHER SURGICAL EQUIPMENT

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0009AA

Aloka Ultrasound (includes Prostate Probe)

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0009AB

Finger T Probe

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0009AC

Laporascopic Probe

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0009AD

Robotic Probe

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0009AE

Abdominal Probe

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0010

BK ULTRASOUND

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0010AA

BK Ultrasound (inlcudes Prostate Probe)

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0010AB

Finger Probe

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0010AC

T Probe

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0010AD

Aloka and BK Ultrasound Standby Fee

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0011

LASERS FOR COSMETIC SURGERY

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0011AA

Vbeam Laser System (first hour from scheduled start time)

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0011AB

Per hour thereafter

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0011AC

Half Day (4 hours)

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0011AD

Full Day (8 hours)

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0011AE

Cryogen Gas

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0012

Medlite

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0012AA

Medlite C6 (first hour from scheduled start time)

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0012AB

Per hour thereafter

Base

11/1/21

10/31/22

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0012AC

Half Day (4 hours)

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0012AD

Full Day (8 hours)

Base

11/1/21

10/31/22

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0013

TECHNICIAN ONLY FOR OPERATION OF VA-OWNED EQUIPMENT

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0013AA

Holmium Technician Only (two hour minimum)

Base

11/1/21

10/31/22

288.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0014

MISCELLANEOUS FEES

Base

11/1/21

10/31/22

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0014AA

Cancellation less than 24 hours before state time

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0014AB

Cancallation upon arrival

Base

11/1/21

10/31/22

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0014AC

Emergency Fee (scheduled start time)

Base

11/1/21

10/31/22

9.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0014AD

After Hours Fee (cases starting after 5p.m.)

Base

11/1/21

10/31/22

9.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0014AE

Weekend/Holiday fee (cases scheduled on weekends or holidays

Base

11/1/21

10/31/22

24.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

0014AF

Extended Hours Fee (cases lasting more than two hours beyond scheduled start time)

Base

11/1/21

10/31/22

24.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1001

GREENLIGHT XPS

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1001AA

Greenlight XPS Procedure

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1001AB

Greenlight XPS Moxy Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1001AC

BPH Cystoscope (if needed)

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1001AD

BPH Standby Fee

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002

HOLMIUM UROLOGY

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002AA

Holmium Urology Procedure

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002AB

200 Micron Reusable Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002AC

365 Micron Reusable Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002AD

550 Micron Reusable Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002AE

1000 Micron Reusable Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002AF

200 Micron Single-Use Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002AG

272 Micron Single-Use Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002AH

273 Micron Single-Use Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002AI

550 Micron Single-Use Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002AJ

1000 Micron Single-Use Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002AK

600um Dual SF Fiber

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1002AL

Standby Fee

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1003

KTP

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1003AA

KTP Procedure

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1003AB

400 Micron Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1003AC

600 Micron Fiber Single-Use

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1003AD

Aura 125 UM Accustat Filter

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1003AE

Aura 100 UM Accustat Filter

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1003AF

Additional for KTP Aura Laser

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1003AG

KTP Standby Fee

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1004

CO2 SURGICAL

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1004AA

CO2 Surgical Procedure

Base

11/1/22

10/31/23

4.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1004AB

Smoke Evaculator with Filter

Base

11/1/22

10/31/23

4.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1004AC

Sterile Tubing

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1004AD

Micromanipulator

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1004AE

Colposcope

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1004AF

Operative Laparoscope

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1004AG

Gyn Instrument

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1004AH

ET Tube

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1004AI

5000L Technology

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1004AJ

Hi Scan Pattern Generator

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1004AK

CO2 Surgical Standby Fee

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1005

CO2 OMNIGUIDE

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1005AA

CO2 Omniguide Procedure

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1005AB

Single-Use Otobeam M Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1005AC

Single-Use Otobeam S Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1005AD

Elevate Elite Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1005AE

BP-Robotic Fiber

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1005AF

Sterile Gas Filter

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1005AG

Instrument Set

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1005AH

CO2 Omniguide Standby Fee

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1006

SPECIALIZED EQUIPMENT

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1006AA

ESWL Table Procedure

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1006AB

Additional Charge for Bilateral Procedure

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1006AC

Additional Charge for Patients300-450 lbs

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1006AD

Standby for less than 72 hours

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1006AE

Cancellation Fee

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1007

CRYO - ENDOCARE (PROSTATE)

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1007AA

Cryo-Endocare for Prostate

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1007AB

Cryo Prostate 206 V Kit

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1007AC

Argon Gas Tank

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1007AD

Helium Gas Tank

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1007AE

Cryo 2.4mm V probe

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1007AF

Additional Temp Probe

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1007AG

Urethral Warming Catheter Kit

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1007AH

B&K Ultrasound Unit (Special Request)

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1008

CRYO - ENDOCARE (RENAL)

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1008AA

Cryo-Endocare for Renal

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1008AB

Renal Kit (includes two probes)

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1008AC

Additonal Renal Probe (choices include):

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1008AD

Renal Cryo Probe R1.7

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1008AE

Renal Cryo Probe R1.7L

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1008AF

Renal Cryo Probe R2.4

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1008AG

Renal Cryo Probe R2.4 Long

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1008AH

Renal Cryo Probe R3.8 Angled

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1008AI

Renal Cryo Probe R3.8 Long

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1008AJ

Cryo Standby Fee

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1009

OTHER SURGICAL EQUIPMENT

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1009AA

Aloka Ultrasound (includes Prostate Probe)

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1009AB

Finger T Probe

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1009AC

Laporascopic Probe

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1009AD

Robotic Probe

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1009AE

Abdominal Probe

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1010

BK ULTRASOUND

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1010AA

BK Ultrasound (inlcudes Prostate Probe)

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1010AB

Finger Probe

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1010AC

T Probe

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1010AD

Aloka and BK Ultrasound Standby Fee

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1011

LASERS FOR COSMETIC SURGERY

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1011AA

Vbeam Laser System (first hour from scheduled start time)

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1011AB

Per hour thereafter

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1011AC

Half Day (4 hours)

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1011AD

Full Day (8 hours)

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1011AE

Cryogen Gas

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1012

Medlite

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1012AA

Medlite C6 (first hour from scheduled start time)

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1012AB

Per hour thereafter

Base

11/1/22

10/31/23

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1012AC

Half Day (4 hours)

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1012AD

Full Day (8 hours)

Base

11/1/22

10/31/23

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1013

TECHNICIAN ONLY FOR OPERATION OF VA-OWNED EQUIPMENT

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1013AA

Holmium Technician Only (two hour minimum)

Base

11/1/22

10/31/23

288.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1014

MISCELLANEOUS FEES

Base

11/1/22

10/31/23

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1014AA

Cancellation less than 24 hours before state time

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1014AB

Cancallation upon arrival

Base

11/1/22

10/31/23

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1014AC

Emergency Fee (scheduled start time)

Base

11/1/22

10/31/23

9.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1014AD

After Hours Fee (cases starting after 5p.m.)

Base

11/1/22

10/31/23

9.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1014AE

Weekend/Holiday fee (cases scheduled on weekends or holidays

Base

11/1/22

10/31/23

24.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

1014AF

Extended Hours Fee (cases lasting more than two hours beyond scheduled start time)

Base

11/1/22

10/31/23

24.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2001

GREENLIGHT XPS

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2001AA

Greenlight XPS Procedure

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2001AB

Greenlight XPS Moxy Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2001AC

BPH Cystoscope (if needed)

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2001AD

BPH Standby Fee

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002

HOLMIUM UROLOGY

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002AA

Holmium Urology Procedure

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002AB

200 Micron Reusable Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002AC

365 Micron Reusable Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002AD

550 Micron Reusable Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002AE

1000 Micron Reusable Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002AF

200 Micron Single-Use Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002AG

272 Micron Single-Use Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002AH

273 Micron Single-Use Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002AI

550 Micron Single-Use Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002AJ

1000 Micron Single-Use Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002AK

600um Dual SF Fiber

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2002AL

Standby Fee

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2003

KTP

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2003AA

KTP Procedure

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2003AB

400 Micron Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2003AC

600 Micron Fiber Single-Use

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2003AD

Aura 125 UM Accustat Filter

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2003AE

Aura 100 UM Accustat Filter

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2003AF

Additional for KTP Aura Laser

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2003AG

KTP Standby Fee

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2004

CO2 SURGICAL

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2004AA

CO2 Surgical Procedure

Base

11/1/23

10/31/24

4.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2004AB

Smoke Evaculator with Filter

Base

11/1/23

10/31/24

4.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2004AC

Sterile Tubing

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2004AD

Micromanipulator

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2004AE

Colposcope

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2004AF

Operative Laparoscope

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2004AG

Gyn Instrument

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2004AH

ET Tube

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2004AI

5000L Technology

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2004AJ

Hi Scan Pattern Generator

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2004AK

CO2 Surgical Standby Fee

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2005

CO2 OMNIGUIDE

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2005AA

CO2 Omniguide Procedure

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2005AB

Single-Use Otobeam M Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2005AC

Single-Use Otobeam S Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2005AD

Elevate Elite Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2005AE

BP-Robotic Fiber

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2005AF

Sterile Gas Filter

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2005AG

Instrument Set

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2005AH

CO2 Omniguide Standby Fee

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2006

SPECIALIZED EQUIPMENT

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2006AA

ESWL Table Procedure

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2006AB

Additional Charge for Bilateral Procedure

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2006AC

Additional Charge for Patients300-450 lbs

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2006AD

Standby for less than 72 hours

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2006AE

Cancellation Fee

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2007

CRYO - ENDOCARE (PROSTATE)

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2007AA

Cryo-Endocare for Prostate

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2007AB

Cryo Prostate 206 V Kit

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2007AC

Argon Gas Tank

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2007AD

Helium Gas Tank

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2007AE

Cryo 2.4mm V probe

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2007AF

Additional Temp Probe

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2007AG

Urethral Warming Catheter Kit

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2007AH

B&K Ultrasound Unit (Special Request)

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2008

CRYO - ENDOCARE (RENAL)

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2008AA

Cryo-Endocare for Renal

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2008AB

Renal Kit (includes two probes)

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2008AC

Additonal Renal Probe (choices include):

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2008AD

Renal Cryo Probe R1.7

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2008AE

Renal Cryo Probe R1.7L

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2008AF

Renal Cryo Probe R2.4

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2008AG

Renal Cryo Probe R2.4 Long

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2008AH

Renal Cryo Probe R3.8 Angled

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2008AI

Renal Cryo Probe R3.8 Long

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2008AJ

Cryo Standby Fee

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2009

OTHER SURGICAL EQUIPMENT

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2009AA

Aloka Ultrasound (includes Prostate Probe)

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2009AB

Finger T Probe

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2009AC

Laporascopic Probe

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2009AD

Robotic Probe

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2009AE

Abdominal Probe

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2010

BK ULTRASOUND

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2010AA

BK Ultrasound (inlcudes Prostate Probe)

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2010AB

Finger Probe

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2010AC

T Probe

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2010AD

Aloka and BK Ultrasound Standby Fee

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2011

LASERS FOR COSMETIC SURGERY

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2011AA

Vbeam Laser System (first hour from scheduled start time)

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2011AB

Per hour thereafter

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2011AC

Half Day (4 hours)

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2011AD

Full Day (8 hours)

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2011AE

Cryogen Gas

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2012

Medlite

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2012AA

Medlite C6 (first hour from scheduled start time)

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2012AB

Per hour thereafter

Base

11/1/23

10/31/24

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2012AC

Half Day (4 hours)

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2012AD

Full Day (8 hours)

Base

11/1/23

10/31/24

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2013

TECHNICIAN ONLY FOR OPERATION OF VA-OWNED EQUIPMENT

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2013AA

Holmium Technician Only (two hour minimum)

Base

11/1/23

10/31/24

288.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2014

MISCELLANEOUS FEES

Base

11/1/23

10/31/24

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2014AA

Cancellation less than 24 hours before state time

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2014AB

Cancallation upon arrival

Base

11/1/23

10/31/24

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2014AC

Emergency Fee (scheduled start time)

Base

11/1/23

10/31/24

9.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2014AD

After Hours Fee (cases starting after 5p.m.)

Base

11/1/23

10/31/24

9.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2014AE

Weekend/Holiday fee (cases scheduled on weekends or holidays

Base

11/1/23

10/31/24

24.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

2014AF

Extended Hours Fee (cases lasting more than two hours beyond scheduled start time)

Base

11/1/23

10/31/24

24.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3001

GREENLIGHT XPS

Base

11/1/24

10/31/25

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3001AA

Greenlight XPS Procedure

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3001AB

Greenlight XPS Moxy Fiber

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3001AC

BPH Cystoscope (if needed)

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3001AD

BPH Standby Fee

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002

HOLMIUM UROLOGY

Base

11/1/24

10/31/25

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002AA

Holmium Urology Procedure

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002AB

200 Micron Reusable Fiber

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002AC

365 Micron Reusable Fiber

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002AD

550 Micron Reusable Fiber

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002AE

1000 Micron Reusable Fiber

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002AF

200 Micron Single-Use Fiber

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002AG

272 Micron Single-Use Fiber

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002AH

273 Micron Single-Use Fiber

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002AI

550 Micron Single-Use Fiber

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002AJ

1000 Micron Single-Use Fiber

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002AK

600um Dual SF Fiber

Base

11/1/24

10/31/25

1.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3002AL

Standby Fee

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3003

KTP

Base

11/1/24

10/31/25

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3003AA

KTP Procedure

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3003AB

400 Micron Fiber

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3003AC

600 Micron Fiber Single-Use

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3003AD

Aura 125 UM Accustat Filter

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3003AE

Aura 100 UM Accustat Filter

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3003AF

Additional for KTP Aura Laser

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3003AG

KTP Standby Fee

Base

11/1/24

10/31/25

2.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3004

CO2 SURGICAL

Base

11/1/24

10/31/25

0.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3004AA

CO2 Surgical Procedure

Base

11/1/24

10/31/25

4.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3004AB

Smoke Evaculator with Filter

Base

11/1/24

10/31/25

4.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3004AC

Sterile Tubing

Base

11/1/24

10/31/25

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3004AD

Micromanipulator

Base

11/1/24

10/31/25

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3004AE

Colposcope

Base

11/1/24

10/31/25

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3004AF

Operative Laparoscope

Base

11/1/24

10/31/25

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3004AG

Gyn Instrument

Base

11/1/24

10/31/25

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3004AH

ET Tube

Base

11/1/24

10/31/25

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3004AI

5000L Technology

Base

11/1/24

10/31/25

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

3004AJ

Hi Scan Pattern Generator

Base

11/1/24

10/31/25

3.00

622110 - General Medical and Surgical Hospitals

Q523 - Medical - Surgery

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Sep 27, 2021.