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PRICE LIST FOR BASE YEAR POP: 10/19/2021-10/18/2022
| ITEM |
| UNIT |
| QTY |
| PRICE |
| TOTAL PRICE |
| Myoview (Tetrofosmin) LEU |
| Dose |
| 1200 |
| Tc99M Unit Dose< 40 mCi LEU |
| <40 mCi |
| 7 |
| Tc99M bulk LEU |
| per mCi |
| 51,500 |
| Tc99M DTPA LEU |
| <40 mCi |
| 13 |
| Tc99M Mebrofenin (Choletec) LEU |
| Dose |
| 70 |
| Tc99M Sulfur Colloid< 10 mCi LEU |
| <10 mCi |
| 10 |
| Tc99M Sulfur Colloid Filtered LEU |
| Dose |
| 110 |
Tc99M Sulfur Colloid Gastric Emptying
| Tc99M PYP Unit Dose LEU |
| Dose |
| 13 |
| Tc99M MAG 3 Unit Dose LEU |
| Dose |
| 30 |
| Tc99M Ceretec labled WBC study LEU |
| Dose |
| 4 |
| Tc99M Ceretec brain Unit Dose LEU |
| Dose |
| 4 |
| Tc99M Neurolite LEU |
| Dose |
| 4 |
| I-123 diagnostic capsule |
| 200 uCi |
| 30 |
| I-123 diagnostic capsule |
| 100 uCi |
| 5 |
| I-131 therapy capsule, (1 mCi) |
| mCi |
| I-131 therapy capsule, (each additional mCi) |
| mCi |
| ln-111 Octreoscan |
| per vial |
| 5 |
| ln-111 WBC study |
| per vial |
| 8 |
| Cholectec - mebrofenin |
| per vial |
| 4 |
| PYP - Sn Pyrophosphate |
| per vial |
| 2 |
*These items and quantities are to be considered as estimates only. Contractor is to invoice only for actual items delivered/received.
PRICE LIST FOR OPTION YEAR 1 POP: 10/19/2022-10/18/2023
| ITEM |
| UNIT |
| QTY |
| PRICE |
| TOTAL PRICE |
| Myoview (Tetrofosmin) LEU |
| Dose |
| 1200 |
| Tc99M Unit Dose< 40 mCi LEU |
| <40 mCi |
| 7 |
| Tc99M bulk LEU |
| per mCi |
| 51,500 |
| Tc99M DTPA LEU |
| <40 mCi |
| 13 |
| Tc99M Mebrofenin (Choletec) LEU |
| Dose |
| 70 |
| Tc99M Sulfur Colloid< 10 mCi LEU |
| <10 mCi |
| 10 |
| Tc99M Sulfur Colloid Filtered LEU |
| Dose |
| 110 |
Tc99M Sulfur Colloid Gastric Emptying
| Tc99M PYP Unit Dose LEU |
| Dose |
| 13 |
| Tc99M MAG 3 Unit Dose LEU |
| Dose |
| 30 |
| Tc99M Ceretec labled WBC study LEU |
| Dose |
| 4 |
| Tc99M Ceretec brain Unit Dose LEU |
| Dose |
| 4 |
| Tc99M Neurolite LEU |
| Dose |
| 4 |
| I-123 diagnostic capsule |
| 200 uCi |
| 30 |
| I-123 diagnostic capsule |
| 100 uCi |
| 5 |
| I-131 therapy capsule, (1 mCi) |
| mCi |
| I-131 therapy capsule, (each additional mCi) |
| mCi |
| ln-111 Octreoscan |
| per vial |
| 5 |
| ln-111 WBC study |
| per vial |
| 8 |
| Cholectec - mebrofenin |
| per vial |
| 4 |
| PYP - Sn Pyrophosphate |
| per vial |
| 2 |
*These items and quantities are to be considered as estimates only. Contractor is to invoice only for actual items delivered/received.
PRICE LIST FOR OPTION YEAR 2 POP: 10/19/2023-10/18/2024
| ITEM |
| UNIT |
| QTY |
| PRICE |
| TOTAL PRICE |
| Myoview (Tetrofosmin) LEU |
| Dose |
| 1200 |
| Tc99M Unit Dose< 40 mCi LEU |
| <40 mCi |
| 7 |
| Tc99M bulk LEU |
| per mCi |
| 51,500 |
| Tc99M DTPA LEU |
| <40 mCi |
| 13 |
| Tc99M Mebrofenin (Choletec) LEU |
| Dose |
| 70 |
| Tc99M Sulfur Colloid< 10 mCi LEU |
| <10 mCi |
| 10 |
| Tc99M Sulfur Colloid Filtered LEU |
| Dose |
| 110 |
Tc99M Sulfur Colloid Gastric Emptying
| Tc99M PYP Unit Dose LEU |
| Dose |
| 13 |
| Tc99M MAG 3 Unit Dose LEU |
| Dose |
| 30 |
| Tc99M Ceretec labled WBC study LEU |
| Dose |
| 4 |
| Tc99M Ceretec brain Unit Dose LEU |
| Dose |
| 4 |
| Tc99M Neurolite LEU |
| Dose |
| 4 |
| I-123 diagnostic capsule |
| 200 uCi |
| 30 |
| I-123 diagnostic capsule |
| 100 uCi |
| 5 |
| I-131 therapy capsule, (1 mCi) |
| mCi |
| I-131 therapy capsule, (each additional mCi) |
| mCi |
| ln-111 Octreoscan |
| per vial |
| 5 |
| ln-111 WBC study |
| per vial |
| 8 |
| Cholectec - mebrofenin |
| per vial |
| 4 |
| PYP - Sn Pyrophosphate |
| per vial |
| 2 |
*These items and quantities are to be considered as estimates only. Contractor is to invoice only for actual items delivered/received.
PRICE LIST FOR OPTION YEAR 3 POP: 10/19/2024-10/18/2025
| ITEM |
| UNIT |
| QTY |
| PRICE |
| TOTAL PRICE |
| Myoview (Tetrofosmin) LEU |
| Dose |
| 1200 |
| Tc99M Unit Dose< 40 mCi LEU |
| <40 mCi |
| 7 |
| Tc99M bulk LEU |
| per mCi |
| 51,500 |
| Tc99M DTPA LEU |
| <40 mCi |
| 13 |
| Tc99M Mebrofenin (Choletec) LEU |
| Dose |
| 70 |
| Tc99M Sulfur Colloid< 10 mCi LEU |
| <10 mCi |
| 10 |
| Tc99M Sulfur Colloid Filtered LEU |
| Dose |
| 110 |
Tc99M Sulfur Colloid Gastric Emptying
| Tc99M PYP Unit Dose LEU |
| Dose |
| 13 |
| Tc99M MAG 3 Unit Dose LEU |
| Dose |
| 30 |
| Tc99M Ceretec labled WBC study LEU |
| Dose |
| 4 |
| Tc99M Ceretec brain Unit Dose LEU |
| Dose |
| 4 |
| Tc99M Neurolite LEU |
| Dose |
| 4 |
| I-123 diagnostic capsule |
| 200 uCi |
| 30 |
| I-123 diagnostic capsule |
| 100 uCi |
| 5 |
| I-131 therapy capsule, (1 mCi) |
| mCi |
| I-131 therapy capsule, (each additional mCi) |
| mCi |
| ln-111 Octreoscan |
| per vial |
| 5 |
| ln-111 WBC study |
| per vial |
| 8 |
| Cholectec - mebrofenin |
| per vial |
| 4 |
| PYP - Sn Pyrophosphate |
| per vial |
| 2 |
*These items and quantities are to be considered as estimates only. Contractor is to invoice only for actual items delivered/received.
PRICE LIST FOR OPTION YEAR 4 POP: 10/19/2025-10/18/2026
| ITEM |
| UNIT |
| QTY |
| PRICE |
| TOTAL PRICE |
| Myoview (Tetrofosmin) LEU |
| Dose |
| 1200 |
| Tc99M Unit Dose< 40 mCi LEU |
| <40 mCi |
| 7 |
| Tc99M bulk LEU |
| per mCi |
| 51,500 |
| Tc99M DTPA LEU |
| <40 mCi |
| 13 |
| Tc99M Mebrofenin (Choletec) LEU |
| Dose |
| 70 |
| Tc99M Sulfur Colloid< 10 mCi LEU |
| <10 mCi |
| 10 |
| Tc99M Sulfur Colloid Filtered LEU |
| Dose |
| 110 |
Tc99M Sulfur Colloid Gastric Emptying
| Tc99M PYP Unit Dose LEU |
| Dose |
| 13 |
| Tc99M MAG 3 Unit Dose LEU |
| Dose |
| 30 |
| Tc99M Ceretec labled WBC study LEU |
| Dose |
| 4 |
| Tc99M Ceretec brain Unit Dose LEU |
| Dose |
| 4 |
| Tc99M Neurolite LEU |
| Dose |
| 4 |
| I-123 diagnostic capsule |
| 200 uCi |
| 30 |
| I-123 diagnostic capsule |
| 100 uCi |
| 5 |
| I-131 therapy capsule, (1 mCi) |
| mCi |
| I-131 therapy capsule, (each additional mCi) |
| mCi |
| ln-111 Octreoscan |
| per vial |
| 5 |
| ln-111 WBC study |
| per vial |
| 8 |
| Cholectec - mebrofenin |
| per vial |
| 4 |
| PYP - Sn Pyrophosphate |
| per vial |
| 2 |
*These items and quantities are to be considered as estimates only. Contractor is to invoice only for actual items delivered/received.