Quotation Estimate Radiologist in United States Los Angeles –Free Word Template Download with AI
Prepared For (Client)
Westside Medical Group, LLC
4820 Wilshire Boulevard, Suite 310
Los Angeles, CA 90036
United States
Attn: Dr. Robert Alvarez, Medical Director
Tel: (310) 555-0142
Prepared By (Provider)
Chen Radiology Associates, P.C.
7001 Santa Monica Boulevard, Floor 12
Los Angeles, CA 90038
United States
Attn: Dr. Margaret Chen, MD, FACR
Tel: (310) 555-0287
This Quotation Estimate is formally issued by Chen Radiology Associates, P.C., a licensed diagnostic imaging practice operating in United States Los Angeles, to provide Westside Medical Group, LLC with a comprehensive and itemized financial projection for the engagement of a board-certified Radiologist to deliver outpatient and inpatient imaging interpretation services. This document serves as a binding cost estimate for the scope of work described herein and is intended to facilitate the client's internal budgeting, procurement approval, and contractual negotiation processes within the Los Angeles metropolitan healthcare market.
The Radiologist engaged under this Quotation Estimate shall provide the following professional services at the client's facility located in the greater Los Angeles, California area. All interpretations will comply with the American College of Radiology (ACR) standards, the California Department of Public Health regulations, and applicable federal guidelines under the United States Code of Federal Regulations (42 CFR Part 482).
| # | Service Description | Frequency / Volume | Unit Rate (USD) | Estimated Total (USD) | Notes |
|---|---|---|---|---|---|
| 1 | CT Scan Interpretation (Chest, Abdomen, Pelvis, Head) | 120 studies/month | $185.00 | $22,200.00 | Per study, includes structured report |
| 2 | MRI Interpretation (Brain, Spine, Joints, Abdomen) | 80 studies/month | $275.00 | $22,000.00 | Per study, includes contrast assessment |
| 3 | Ultrasound Interpretation (Abdominal, Vascular, OB/GYN) | 150 studies/month | $120.00 | $18,000.00 | Per study, real-time guidance included |
| 4 | Mammography & Breast Imaging Interpretation | 200 studies/month | $145.00 | $29,000.00 | ACR BI-RADS reporting standard |
| 5 | X-Ray / Plain Film Interpretation (Chest, Extremity, Spine) | 300 studies/month | $65.00 | $19,500.00 | Per study, includes PACS review |
| 6 | Interventional Radiology Procedures (Biopsy, Drainage, Angiography) | 25 procedures/month | $1,200.00 | $30,000.00 | Per procedure, includes post-procedure report |
| 7 | Emergency / After-Hours On-Call Coverage | 4 shifts/month (12-hr) | $850.00 | $3,400.00 | Includes telephonic and in-person response |
| 8 | Consultation & MDT (Multidisciplinary Team) Participation | 8 sessions/month | $350.00 | $2,800.00 | Per session, in-person at LA facility |
| Subtotal (Monthly Services) | $146,900.00 |
| Annualized Service Total (12 months) | $1,762,800.00 |
| California State Sales & Use Tax (Exempt — Medical Services) | $0.00 |
| Malpractice & Professional Liability Insurance Surcharge | $18,500.00 |
| PACS Integration & IT Support Fee (One-Time Setup) | $4,200.00 |
| GRAND TOTAL (Annual, USD) | $1,785,500.00 |
- Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issuance. After the expiration date, all rates are subject to revision based on prevailing market conditions in the United States Los Angeles healthcare sector.
- Payment Terms: Invoices shall be issued on the first business day of each calendar month for services rendered in the preceding month. Payment is due within thirty (30) days of invoice date via ACH transfer or certified check. Late payments shall accrue interest at 1.5% per month as permitted under California Commercial Code Section 2210.
- Scope Limitations: The Radiologist services outlined herein are limited to the volumes and modalities specified in Section 2. Any additional studies, emergency activations beyond the allocated on-call shifts, or new imaging modalities (e.g., PET/CT, Nuclear Medicine) will be billed separately at rates to be agreed upon in writing.
- Licensing & Compliance: The Radiologist shall maintain an active, unrestricted California medical license, a valid DEA registration, and board certification through the American Board of Radiology (ABR) for the duration of the engagement. All services shall be performed in compliance with HIPAA, the California Confidentiality of Medical Information Act (CMIA), and ACR accreditation standards.
- Insurance: The provider shall carry a minimum of $5,000,000 in professional liability (malpractice) insurance per occurrence and $10,000,000 in aggregate, with Westside Medical Group, LLC named as an additional insured. Certificates of insurance shall be provided prior to the commencement of services.
- Termination: Either party may terminate this engagement with sixty (60) days written notice. In the event of termination, the client shall be responsible for all services rendered through the effective date of termination.
- Governing Law: This Quotation Estimate and any resulting contract shall be governed by and construed in accordance with the laws of the State of California, United States. Any disputes shall be resolved through binding arbitration in Los Angeles County, California, in accordance with the rules of the American Arbitration Association.
- Confidentiality: All patient information, imaging data, and proprietary business information exchanged in connection with this engagement shall be treated as strictly confidential and shall not be disclosed to third parties without prior written consent, in accordance with applicable United States federal and California state privacy laws.
- Force Majeure: Neither party shall be liable for failure to perform obligations due to events beyond reasonable control, including but not limited to natural disasters, pandemics, government-mandated closures, or acts of war affecting the United States Los Angeles region.
By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms, conditions, and financial projections set forth herein for the engagement of the Radiologist services described. This signature does not constitute a final contract but serves as an expression of intent to proceed to formal contract execution within the validity period stated above.
For Westside Medical Group, LLC (Client)Name: ______________________________
Title: Medical Director
Date: ______________________________ For Chen Radiology Associates, P.C. (Provider)
Name: Dr. Margaret Chen, MD, FACR
Title: Principal Radiologist / Owner
Date: ______________________________ ⬇️ Download as DOCX Edit online as DOCX
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