26PSX0075 - Exhibit B - Price Schedule - Non-Medicaid Tests only.xlsx

This is a Price Schedule Exhibit (Exhibit B) for contract 26PSX0075 related to Clinical Laboratory Services in Connecticut, establishing the contractor's rate schedule for non-Medicaid covered tests. The document outlines the pricing structure that contractors must submit for diagnostic laboratory tests that fall outside the state's Medicaid coverage schedule, including services such as comprehensive metabolic panels, lipid panels, and other clinical laboratory analyses performed on blood, urine, sputum, fecal specimens, and tissue samples. The price schedule format requires contractors to identify each test by code, provide the test name and description, confirm whether the test is covered under Medicaid, include the applicable CPT/HCPCS code, and list the proposed price for each service offered.

Pricing for non-Medicaid covered tests must be clearly itemized in the contractor's rate schedule, with the examples provided showing a Comprehensive Metabolic Panel priced at $45.00 and a Lipid Panel at $3.50. Contractors are specifically instructed to include only those tests that are not on the Medicaid schedule in this exhibit, ensuring clear differentiation between covered and non-covered services. The price schedule serves as the binding rate agreement for all non-Medicaid laboratory services rendered under the contract, with each test line item requiring identification of the test code, description, Medicaid coverage status, corresponding procedure code, and the contractor's proposed unit price.