Suppliers Must Enter Firm Prices for All Contracted Years

Agreement Period: May 1, 2017 through April 30, 2022 Suppliers must enter firm prices for all contracted years.

ESTIMATED UNIT QUANTITY PRICE TOTAL

Abdomen 1-View 1780 ea. $______$______

Abdomen 2-View 255 ea. $______$______

Abdomen 3-View 230 ea. $______$______

Ankle (AP & oblique, lateral) 330 ea. $______$______

Bone Density Study 340 ea. $______$______

Set-Up Fee for Bone Density 245 ea. $______$______

Calcaneus 120 ea. $______$______

Cervical Spine (AP & Lateral) 255 ea. $______$______

Chest (AP) 2230 ea. $______$______

Chest (AP & Lateral) 935 ea. $______$______

Clavicle (AP, AP Angle 15 degrees) 145 ea. $______$______

Dorsal Spine 135 ea. $______$______

Echo Cardiogram 515 ea. $______$______

EKG with Interpretation 3245 ea. $______$______

Set-Up Fee for EKG 435 ea. $______$______

Elbow (AP, external oblique, 300 ea. $______$______Lateral)

Elbow Complete 215 ea. $______$______

Facial Bones (water,lateral arches) 275 ea. $______$______

Femur (AP & Lateral) 225 ea. $______$______

Finger 200 ea. $______$______

Foot, complete, 3V 405 ea. $______$______

Foot (AP & Lateral) 395 ea. $______$______Forearm (AP & Lateral) 205 ea. $______$______

Hand (AP, oblique lateral) 385 ea. $______$______

Hand, 3 views 190 ea. $______$______

Hip, Unilateral 340 ea. $______$______

Hip, bilateral pelvis 220 ea. $______$______

Holter/Print out/ 165 ea. $______$______RPT interpretation

Humerus (AP & Lateral) 165 ea. $______$______

Knee (AP & Lateral 440 ea. $______$______

Knee, 3 view 187 ea. $______$______

Lower Leg (AP & Lateral) 125 ea. $______$______

Lumbar Spine (AP & Lateral) 325 ea. $______$______

Mammogram (bilateral) 960 ea. $______$______

Mammogram, (unilateral) 126 ea. $______$______

Set-Up fee/Site Visit, 240 ea. $______$______Mammogram

Mandible 125 ea. $______$______

Nasal Bones(waters, both laterals) 190 ea. $______$______

Orbit 145 ea. $______$______

Pelvis 240 ea. $______$______

Ribs (Bilateral) 180 ea. $______$______

Ribs (Unilateral) 205 ea. $______$______

Sacrum/Coccyx MIN 2V 155 ea. $______$______

Scapula Complete 120 ea. $______$______

Shoulder (Internal & external 275 ea. $______$______Rotation)

Sinuses (waters, PA lateral) 165 ea. $______$______Skull (AP, townes, both laterals) 250 ea. $______$______

Tibia/Fibula 217 ea. $______$______

Toe 180 ea. $______$______

Thoracic Spine AP & Lateral 340 ea. $______$______

ULTRASOUNDS Breast 210 ea. $______$______Abdomen Complete 690 ea. $______$______Renal-Retroperitone 440 ea. $______$______Pelvis Complete 285 ea. $______$______Pelvis Limited 145 ea. $______$______Extremity Ultrasound 195 ea. $______$______Thyroid 290 ea. $______$______Gall Bladder US 25 ea.

Vascular Studies 251 ea. $______$______

Wrist (AP, oblique, lateral) 200 ea. $______$______

Wrist (complete) 165 ea. $______$______

Set up Fees for X-Rays 1040 ea. $______$______

Arteries Doppler-Carotid 20 ea. $______$______

Bilateral Arterial 30 ea. $______$______

Ven Doppler Extrem/Lim 70 ea. $______$______

Ultrasound-Scrotum 20 ea. $______$______

Duplex Scan Arterial 10 ea. $______$______

Pulmonary Function Test 7 ea. $______$______

TOTAL FOR 5/1/17-4/30/22 $______