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36C25519Q0805 FedBizOpps Combined Synopsis/Solicitation Notice
CLASSIFICATION CODE
SUBJECT
CONTRACTING OFFICE'S
ZIP-CODE
SOLICITATION NUMBER
RESPONSE DATE
(MM-DD-YYYY)
ARCHIVE
DAYS AFTER THE RESPONSE DATE
RECOVERY ACT FUNDS
SET-ASIDE
NAICS CODE
CONTRACTING OFFICE
ADDRESS
POINT OF CONTACT
(POC Information Automatically Filled from User Profile Unless Entered)
DESCRIPTION
See Attachment
AGENCY'S URL
URL DESCRIPTION
AGENCY CONTACT'S EMAIL
ADDRESS
EMAIL DESCRIPTION
ADDRESS
POSTAL CODE
COUNTRY
ADDITIONAL INFORMATION
GENERAL INFORMATION
PLACE OF PERFORMANCE
Required Field FedBizOpps Combined Synopsis/Solicitation Notice Rev. March 2010 Q Copy of On-Site Pathology Services - Wichita - Follow-on 66048 36C25519Q0805 11-13-2019 N 621511 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth KS 66048 Pathology Services
PAGE 1 OF
1. REQUISITION NO.
2. CONTRACT NO.
3. AWARD/EFFECTIVE DATE
4. ORDER NO.
5. SOLICITATION NUMBER
6. SOLICITATION ISSUE DATE
a. NAME
b. TELEPHONE NO. (No Collect Calls)
8. OFFER DUE DATE/LOCAL
TIME
9. ISSUED BY
CODE
10. THIS ACQUISITION IS
UNRESTRICTED OR
SET ASIDE:
% FOR:
SMALL BUSINESS
HUBZONE SMALL
BUSINESS
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
WOMEN-OWNED SMALL BUSINESS
(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED
SMALL BUSINESS PROGRAM
EDWOSB
8(A)
NAICS:
SIZE STANDARD:
11. DELIVERY FOR FOB DESTINA-
TION
UNLESS BLOCK IS
MARKED
SEE SCHEDULE
12. DISCOUNT TERMS
13a. THIS CONTRACT IS A
RATED ORDER UNDER
DPAS (15 CFR 700)
13b. RATING
14. METHOD OF SOLICITATION
RFQ
IFB
RFP
15. DELIVER TO
CODE
16.
ADMINISTERED BY
CODE
17a. CONTRACTOR/OFFEROR
CODE
FACILITY CODE
18a. PAYMENT WILL BE MADE BY
CODE
TELEPHONE NO.
DUNS:
DUNS+4:
PHONE:
FAX:
17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b.
SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED
SEE ADDENDUM
19.
20.
21.
22.
23.
24.
ITEM NO.
SCHEDULE OF SUPPLIES/SERVICES
QUANTITY
UNIT
UNIT PRICE
AMOUNT
(Use Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA
26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA
ARE
ARE NOT ATTACHED.
27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA
ARE
ARE NOT ATTACHED
28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________
29. AWARD OF CONTRACT: REF. ___________________________________ OFFER
COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND
DATED ________________________________
. YOUR OFFER ON SOLICITATION
DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY
(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE
ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED
SET FORTH HEREIN IS
ACCEPTED AS TO ITEMS:
30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED
AUTHORIZED FOR LOCAL REPRODUCTION
(REV. 2/2012)
PREVIOUS EDITION IS NOT USABLE
Prescribed by GSA - FAR (48 CFR) 53.212
7. FOR SOLICITATION
INFORMATION CALL:
STANDARD FORM 1449
OFFEROR TO COMPLETE BLOCKS 12, 17,
23, 24, & 30
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS
36C25519Q0805 10- -2019 Donahue-MacDonald, Colleen, Contracting Officer (CO) 913-946-1123 11- -2019 36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth KS 66048 X Y 621511 $32.5 Million N/A X Robert J.
Dole VAMC 5500 E. Kellogg Ave Wichita, KS 67218
36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth KS 66048
36C255 Department of Veterans Affairs Financial Services Center http://www.fsc.va.gov/einvoice.asp Austin TX 877-353-9791 512-460-5429 Pathology Services This solicitation is issued under the authority of title 38 U.S.C. 8153 for non-personal services for Pathology services as defined in the solicitation and the Performance Work Statement (PWS). See Section B.2, Schedule of services.
The purpose of this solicitation is to establish an Indefinite Delivery/Indefinite Quantity (IDIQ) contract.
The period of performance: Base Year plus four (4) one (1) year option periods, if authorized by the Contracting Officer.
$0.00 X X Colleen Donahue-MacDonald Contracting Officer Table of Contents
| SECTION A | 3 |
| A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS | 3 |
| SECTION B - CONTINUATION OF SF 1449 BLOCKS | 6 |
| B.2 PRICE/COST SCHEDULE | 8 |
| SECTION C - CONTRACT CLAUSES | 69 |
| C.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) | 69 |
| C.2 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (OCT 2018) | 69 |
| C.3 52.216-18 ORDERING (OCT 1995) | 75 |
| C.4 52.216-19 ORDER LIMITATIONS (OCT 1995) | 75 |
| C.5 52.216-21 REQUIREMENTS (OCT 1995) ALTERNATE I (APR 1984) | 76 |
| C.6 52.216-22 INDEFINITE QUANTITY (OCT 1995) | 77 |
| C.7 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) | 77 |
| C.8 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) | 78 |
| C.9 52.232-18 AVAILABILITY OF FUNDS (APR 1984) | 78 |
| C.10 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) | 78 |
| C.11 52.228-5 INSURANCE—WORK ON A GOVERNMENT INSTALLATION (JAN 1997) | 78 |
| C.12 CL-120 SUPPLEMENTAL INSURANCE REQUIREMENTS | 79 |
| C.13 52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS SUBCONTRACTORS (DEC 2013) | 79 |
| C.14 VAAR 852.211-72 TECHNICAL INDUSTRY STANDARDS (NOV 2018) | 80 |
| C.15 VAAR 852.217-70 CONTRACT ACTION DEFINITIZATION (JUL 2019) | 80 |
| C.16 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018) | 81 |
| C.17 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 2008) | 82 |
| C.18 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984) | 83 |
| C.19 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) | 84 |
| C.20 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (MAY 2019) | 84 |
| SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS | 92 |
| SECTION E - SOLICITATION PROVISIONS | 93 |
| E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (OCT 2018) | 93 |
| E.2 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998) | 100 |
| E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018) | 101 |
| E.4 52.216-1 TYPE OF CONTRACT (APR 1984) | 102 |
| E.5 52.233-2 SERVICE OF PROTEST (SEP 2006) | 102 |
| E.6 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (JAN 2008) | 103 |
| E.7 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016)(DEVIATION) | 103 |
| E.8 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009) | 104 |
| E.9 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (OCT 2018) | 104 |
| E.10 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018) | 105 |
| E.11 VAAR 852.273-73 EVALUATION - HEALTH-CARE RESOURCES (JAN 2003) | 105 |
| E.12 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL ITEMS (OCT 2018) | 106 |
SECTION B - CONTINUATION OF SF 1449 BLOCKS
B.1 CONTRACT ADMINISTRATION DATA
1. Contract Administration: All contract administration matters will be handled by the following individuals:
a. CONTRACTOR (Offerors are required to designate a person for prompt administration):
Name of Company:
| Name: | ____ __ |
| Title: | ____ __ |
Address:
| | _____ _ |
| Fax No.: | _ __________ _ | |
DUNS Number: ________________________________
b. GOVERNMENT: Contracting Officer
| | Colleen Donahue-MacDonald |
| Department of Veterans Affairs | | |
| Network Contracting Office (NCO) 15 | | |
| 3450 South 4th Street | | |
| Leavenworth KS 66048 | | |
| Phone: (913) 946-1123 | |
2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:
| [X] | 52.232-33, Payment by Electronic Funds Transfer - |
| Other than Central Contractor Registration, or |
[] 52.232-36, Payment by Third Party
3. INVOICES: Invoices shall be submitted in arrears:
| a. Quarterly | [] | | |
| b. Semi-Annually | | [] | |
| c. Other | | | [X] Monthly in arrears |
4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.
Department of Veterans Affairs Financial Services Center http://www.fsc.va.gov/einvoice.asp Austin TX
ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:
AMENDMENT NO DATE
5. SECURE FAX: In accordance with VA Handbook 6500, the following statement is required on all fax cover sheets; if it is determined the ordering process will include a fax: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.”
6. POST-AWARD ORIENTATION (Contract Awards Exceeding $1M): The Contracting Officer will schedule a post-award orientation conference for contract orientation purposes as required by Procurement Policy Memorandum (PPM) (https://www.va.gov/oal/docs/business/pps/ppm201901.pdf).
7. SUBCONTRACTING PLAN--MONITORING AND COMPLIANCE (JUN 2011)
This solicitation includes FAR 52.219-9, Small Business Subcontracting Plan, and VAAR 852.219-9, VA Small Business Subcontracting Plan Minimum Requirement. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing the contractor's compliance with the plan, including reviewing the contractor's accomplishments in achieving the subcontracting goals in the plan. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting plan.
B.2 PRICE/COST SCHEDULE
SCHEDULE OF SERVICES
The Contractor shall furnish all personnel to provide services necessary to perform off-site and on-site Pathology/Pathologist Services to eligible beneficiaries of the Robert J. Dole, Department of Veterans Affairs Medical Center (VAMC), Wichita, KS (hereinafter referred to as VAMC). The Contractor shall cover the range of Pathology services meeting or exceeding currently recognized national standards American Board of Medical Specialties (ABMS) www.ABMS.org and the American Board of Pathology http://abpath.org/index.php/to-become-certified/requirements-for-certification.
Contract type is Firm Fixed Price, Indefinite Delivery Indefinite Quantity. Contractor shall price base and option years(s) the same. Contractor will only be compensated for on-call services that are actually performed.
a. The contract line items (CLINs) listed in the price schedules are to identify the anticipated range of test required so as to define scope. The Government cannot predetermine, above the stated minimum, the precise quantities of services the Government will require during the contract period. While it is impossible to accurately forecast the quantity and time of delivery for each CLIN, line items marked with a “- “estimated quantity indicate the test has historically not been performed but does not preclude the test from being ordered at a future time and within stated order limits.
b. The pricing is inclusive of all peripheral services and supplies required for the respective CPT codes as stated in the Performance Work Statement (PWS) to include, but not be limited to reagents, and reading of results.
c. Option years shall be priced at the Medicare rate in effect at the time of the exercising of the option period with the same percentage increase or decrease applied to the Medicare rate as quoted for the base year pricing. Rates will remain the same for the full option period.
Estimated Period of Performance: BASE YEAR: January 1, 2020 to December 31, 2020
CPT codes to be for Off-site services
Contract Line Item
(CLIN)
| SUB-CLINs |
| CPT Code |
| Description |
| Medicare Geographic Rates (KS) |
Estimated Amount
| Unit |
| % Discount to the Medicare Geographic Rate |
| Total Price |
Pathology Current Procedural Terminology Off-site services
| 0001A |
| 80500 |
| Clinical pathology consultation; limited, without review of patient’s history and medical records. |
| $22.31 |
| 1 |
| EA |
| 0001B |
| 85060 |
| Blood Smear Interpretation with Report |
| $24.21 |
| 5 |
| EA |
| 0001C |
| 85097 |
| Bone Marrow; Smear Interpretation |
| $71.76 |
| 24 |
| EA |
| 0001D |
| 88104 |
| Cytopathology, fluids, except cervical & Vaginal; smears; global |
| $66.59 |
| 1 |
| EA |
| 0001E |
| 88104-TC |
| Cytopathology fluids, except cervical & Vaginal; smears; technical component |
| $37.98 |
| 1 |
| EA |
| 0001F |
| 88104-26 |
| Cytopathology, fluids, except cervical & Vaginal; smears; professional component |
| $28.61 |
| 1 |
| EA |
| 0001G |
| 88106 |
| Cytopathology, fluids, except cervical & Vaginal; filter |
| $60.40 |
| 1 |
| EA |
| 0001H |
| 88108 |
| Cytopathology, concentration technique, Smears & Interpret; global |
| $57.34 |
| 3 |
| EA |
| 0001I |
| 88108-TC |
| Cytopathology, concentration technique, Smears & Interpret; technical component |
| $34.69 |
| 3 |
| EA |
| 0001J |
| 88108-26 |
| Cytopathology, concentration technique, Smears & Interpret; professional component |
| $22.65 |
| 1 |
| EA |
| 0001K |
| 88112 |
| Cytopathology, liquid based slide preparation (SUREPATH); global |
| $63.96 |
| 20 |
| EA |
| 0001L |
| 88112-TC |
| Cytopathology, liquid based slide preparation (SUREPATH); technical component |
| $25.24 |
| 170 |
| EA |
| 0001M |
| 88112-26 |
| Cytopathology, liquid based slide preparation (SUREPATH); professional component |
| $30.68 |
| 1 |
| EA |
| 0001N |
| 88125 |
| Cytopathology, forensic (eg, sperm) |
| $0.00 |
| 1 |
| EA |
| 0001O |
| 88141 |
| Cytopathology; cervical or vaginal, interpretation by a physician; global |
| $0.00 |
| 25 |
| EA |
| 0001P |
| 88160 |
| Cytopathology; any other source, screen & interpretation; global |
| $67.38 |
| 1 |
| EA |
| 0001Q |
| 88160-TC |
| Cytopathology; any other source, screen & interpretation; technical component |
| $41.26 |
| 9 |
| EA |
| 0001R |
| 88160-26 |
| Cytopathology; any other source, screen & interpretation; professional component |
| $26.12 |
| 1 |
| EA |
| 0001S |
| 88161 |
| Cytopathology; any other source, preparation, screen & interp.; global |
| $62.79 |
| 1 |
| EA |
| 0001T |
| 88161-TC |
| Cytopathology; any other source, preparation, screen & interp.; technical component |
| $37.32 |
| 1 |
| EA |
| 0001U |
| 88161-26 |
| Cytopathology; any other source, preparation, screen & interp; professional component. |
| $25.46 |
| 1 |
| EA |
| 0001V |
| 88172 |
| Cytopathology, eval. of fine needle aspirate; deter. adequacy |
| $54.42 |
| 1 |
| EA |
| 0001W |
| 88173 |
| Cytopathology, eval. of fine needle aspirate; interp. And report; global |
| $145.76 |
| 6 |
| EA |
| 0001X |
| 88173-TC |
| Cytopathology, eval. of fine needle aspirate; interp. And report; technical component |
| $74.31 |
| 49 |
| EA |
| 0001Y |
| 88173-26 |
| Cytopathology, eval. of fine needle aspirate; interp; professional component |
| $71.44 |
| 1 |
| EA |
| 0001Z |
| 88182 |
| Cell Marker study |
| $126.37 |
| 1 |
| EA |
| 0001AA |
| 88184 |
| Flow Cytometry, cell, cytoplasmic, nuclear marker tech. only: first marker |
| $61.51 |
| 1 |
| EA |
| 0001AB |
| 88185 |
| Flow Cytometry, each additional marker, tech. only |
| $22.65 |
| 1 |
| EA |
| 0001AC |
| 88187 |
| Flow Cytometry, interpretation; 2 to 8 markers |
| $37.51 |
| 5 |
| EA |
| 0001AD |
| 88188 |
| Flow Cytometry, interpretation; 9 to 15 markers |
| $63.29 |
| 31 |
| EA |
| 0001AE |
| 88189 |
| Flow Cytometry, interpretation; 16 or more markers |
| $85.04 |
| 75 |
| EA |
| 0001AF |
| 88300 |
| Surg. Path., Gross Only, Level I; global |
| $14.82 |
| 18 |
| EA |
| 0001AG |
| 88300-TC |
| Surg. Path., Gross Only, Level I; technical component |
| $10.40 |
| 1 |
| EA |
| 0001AH |
| 88300-26 |
| Surg. Path., Gross Only, Level I; professional component |
| $4.42 |
| 1 |
| EA |
| 0001AI |
| 88302 |
| Surg. Path., Gross Only, Level II; global |
| $28.77 |
| 13 |
| EA |
| 0001AJ |
| 88302-TC |
| Surg. Path., Gross Only, Level II; technical component |
| $21.89 |
| 10 |
| EA |
| 0001AK |
| 88302-26 |
| Surg. Path., Gross Only, Level II; professional component |
| $6.88 |
| 1 |
| EA |
| 0001AL |
| 88304 |
| Surg. Path., Gross Only, Level III; global |
| $37.92 |
| 250 |
| EA |
| 0001AM |
| 88304-TC |
| Surg. Path., Gross Only, Level III; technical component |
| $26.49 |
| 30 |
| EA |
| 0001AN |
| 88304-26 |
| Surg. Path., Gross Only, Level III; professional component |
| $11.43 |
| 1 |
| EA |
| 0001AO |
| 88305 |
| Surg. Path., Gross Only, Level IV; global |
| $66.11 |
| 4114 |
| EA |
| 0001AP |
| 88305-TC |
| Surg. Path., Gross Only, Level IV; technical component |
| $27.80 |
| 451 |
| EA |
| 0001AQ |
| 88305-26 |
| Surg. Path., Gross Only, Level IV; professional component |
| $38.31 |
| 1 |
| EA |
| 0001AR |
| 88307 |
| Surg. Path., Gross Only, Level V; global |
| $253.65 |
| 145 |
| EA |
| 0001AS |
| 88307-TC |
| Surg. Path., Gross Only, Level V; technical component |
| $169.85 |
| 16 |
| EA |
| 0001AT |
| 88307-26 |
| Surg. Path., Gross Only, Level V; professional component |
| $83.80 |
| 1 |
| EA |
| 0001AU |
| 88309 |
| Surg. Path., Gross Only, Level IV; global |
| $386.46 |
| 24 |
| EA |
| 0001AV |
| 88309-TC |
| Surg. Path., Gross Only, Level IV; technical component |
| $238.37 |
| 3 |
| EA |
| 0001AW |
| 88309-26 |
| Surg. Path., Gross Only, Level IV; professional component |
| $148.10 |
| 1 |
| EA |
| 0001AX |
| 88311 |
| Decalcify Tissue; global |
| $20.58 |
| 90 |
| EA |
| 0001AY |
| 88311-TC |
| Decalcify Tissue; technical component |
| $8.10 |
| 9 |
| EA |
| 0001AZ |
| 88311-26 |
| Decalcify Tissue; professional component |
| $12.48 |
| 1 |
| EA |
| 0001BA |
| 88312 |
| Special Stains, Group I; global |
| $94.43 |
| 319 |
| EA |
| 0001BB |
| 88312-TC |
| Special Stains, Group I; technical component |
| $67.53 |
| 36 |
| EA |
| 0001BC |
| 88312-26 |
| Special Stains, Group I; professional component |
| $26.91 |
| 1 |
| EA |
| 0001BD |
| 88313 |
| Special Stains, Group II; global |
| $67.86 |
| 118 |
| EA |
| 0001BE |
| 88313-TC |
| Special Stains, Group II; technical component |
| $55.71 |
| 10 |
| EA |
| 0001BF |
| 88313-26 |
| Special Stains, Group II; professional component |
| $12.15 |
| 1 |
| EA |
| 0001BG |
| 88314 |
| Special Stains, Histochem. w/Frozen Section |
| $86.59 |
| 1 |
| EA |
| 0001BH |
| 88319 |
| Determinative histochemistry or cytochemistry to identify enzyme |
| $91.45 |
| 1 |
| EA |
| 0001BI |
| 88321 |
| Consultation and report on referred slides prepared elsewhere |
| $97.94 |
| 20 |
| EA |
| 0001BJ |
| 88323 |
| Consultation and report on referred material requiring preparation of slides |
| $113.13 |
| 1 |
| EA |
| 0001BK |
| 88325 |
| Consultation, comprehensive, review records with report |
| $175.75 |
| 1 |
| EA |
| 0001BL |
| 88329 |
| Pathology consultation during surgery |
| $49.98 |
| 1 |
| EA |
| 0001BM |
| 88331 |
| Pathology consultation during surgery first tissue block with frozen |
| $93.68 |
| 4 |
| EA |
| 0001BN |
| 88332 |
| Pathology consolation during surgery each additional tissue block with frozen |
| $51.25 |
| 6 |
| EA |
| 0001BO |
| 88333 |
| Pathology consolation during surgery cytologic exam (touch prep) initial |
| $86.49 |
| 1 |
| EA |
| 0001BP |
| 88334 |
| Pathology consolation during surgery cytologic exam (touch prep) initial |
| $54.00 |
| 1 |
| EA |
| 0001BQ |
| 88341 |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); global |
| $87.71 |
| 653 |
| EA |
| 0001BR |
| 88341-TC |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); technical component |
| $58.77 |
| 70 |
| EA |
| 0001BS |
| 88341-26 |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); professional component |
| $28.94 |
| 1 |
| EA |
| 0001BT |
| 88342 |
| Immunohistochemistry (including immunoperoxidase) each antibody; global |
| $100.75 |
| 201 |
| EA |
| 0001BU |
| 88342-TC |
| Immunohistochemistry (including immunoperoxidase) each antibody; technical component |
| $64.90 |
| 20 |
| EA |
| 0001BV |
| 88342-26 |
| Immunohistochemistry (including immunoperoxidase) each antibody; professional component |
| $35.85 |
| 1 |
| EA |
| 0001BW |
| 88346 |
| Immunofluorescent study, each antibody; direct method |
| $104.16 |
| 1 |
| EA |
| 0001BX |
| 88347 |
| Immunofluorescent study, each antibody; indirect method |
| $0.00 |
| 1 |
| EA |
| 0001BY |
| 88348 |
| Electron microscopy, diagnostic |
| $337.23 |
| 1 |
| EA |
| 0001BZ |
| 88360 |
| Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody, manual |
| $120.60 |
| 1 |
| EA |
| 0001CA |
| 88361 |
| M/PHMTRC ALYS TUM IMHCEM ANTB CPTB |
| $124.86 |
| 1 |
| EA |
| 0001CB |
| 88365 |
| SITU HYBRIDIZATIOHN EA PRB |
| $166.33 |
| 1 |
| EA |
| 0001CD |
| 88368 |
| M/PHMTRC ALYS ISH EA PRB MNL |
| $120.37 |
| 1 |
| EA |
Total CLIN 001
Description
KEY PERSONNEL
CLIN
SUB-CLINs
.033 FTE Board Certified/Board Eligible Pathologist to perform on-site Pathology services
HR
Rank:
HR
Rank:
Total CLIN 002
Estimated Period of Performance: OPTION 1: January 1, 2021 to December 31, 2021
CPT codes to be for Off-site services
Contract Line Item
| SUB-CLINs |
| CPT Code |
| Description |
| Medicare Geographic Rates (KS) |
Estimated Amount
| Unit |
| % Discount to the Medicare Geographic Rate |
| Total Price |
Pathology Current Procedural Terminology Off-site services
| 1001A |
| 80500 |
| Clinical pathology consultation; limited, without review of patient’s history and medical records. |
| $22.31 |
| 1 |
| EA |
| 1001B |
| 85060 |
| Blood Smear Interpretation with Report |
| $24.21 |
| 5 |
| EA |
| 1001C |
| 85097 |
| Bone Marrow; Smear Interpretation |
| $71.76 |
| 24 |
| EA |
| 1001D |
| 88104 |
| Cytopathology, fluids, except cervical & Vaginal; smears; global |
| $66.59 |
| 1 |
| EA |
| 1001E |
| 88104-TC |
| Cytopathology fluids, except cervical & Vaginal; smears; technical component |
| $37.98 |
| 1 |
| EA |
| 1001F |
| 88104-26 |
| Cytopathology, fluids, except cervical & Vaginal; smears; professional component |
| $28.61 |
| 1 |
| EA |
| 1001G |
| 88106 |
| Cytopathology, fluids, except cervical & Vaginal; filter |
| $60.40 |
| 1 |
| EA |
| 1001H |
| 88108 |
| Cytopathology, concentration technique, Smears & Interpret; global |
| $57.34 |
| 3 |
| EA |
| 1001I |
| 88108-TC |
| Cytopathology, concentration technique, Smears & Interpret; technical component |
| $34.69 |
| 3 |
| EA |
| 1001J |
| 88108-26 |
| Cytopathology, concentration technique, Smears & Interpret; professional component |
| $22.65 |
| 1 |
| EA |
| 1001K |
| 88112 |
| Cytopathology, liquid based slide preparation (SUREPATH); global |
| $63.96 |
| 20 |
| EA |
| 1001L |
| 88112-TC |
| Cytopathology, liquid based slide preparation (SUREPATH); technical component |
| $25.24 |
| 170 |
| EA |
| 1001M |
| 88112-26 |
| Cytopathology, liquid based slide preparation (SUREPATH); professional component |
| $30.68 |
| 1 |
| EA |
| 1001N |
| 88125 |
| Cytopathology, forensic (eg, sperm) |
| $0.00 |
| 1 |
| EA |
| 1001O |
| 88141 |
| Cytopathology; cervical or vaginal, interpretation by a physician; global |
| $0.00 |
| 25 |
| EA |
| 1001P |
| 88160 |
| Cytopathology; any other source, screen & interpretation; global |
| $67.38 |
| 1 |
| EA |
| 1001Q |
| 88160-TC |
| Cytopathology; any other source, screen & interpretation; technical component |
| $41.26 |
| 9 |
| EA |
| 1001R |
| 88160-26 |
| Cytopathology; any other source, screen & interpretation; professional component |
| $26.12 |
| 1 |
| EA |
| 1001S |
| 88161 |
| Cytopathology; any other source, preparation, screen & interp.; global |
| $62.79 |
| 1 |
| EA |
| 1001T |
| 88161-TC |
| Cytopathology; any other source, preparation, screen & interp.; technical component |
| $37.32 |
| 1 |
| EA |
| 1001U |
| 88161-26 |
| Cytopathology; any other source, preparation, screen & interp; professional component. |
| $25.46 |
| 1 |
| EA |
| 1001V |
| 88172 |
| Cytopathology, eval. of fine needle aspirate; deter. adequacy |
| $54.42 |
| 1 |
| EA |
| 1001W |
| 88173 |
| Cytopathology, eval. of fine needle aspirate; interp. And report; global |
| $145.76 |
| 6 |
| EA |
| 1001X |
| 88173-TC |
| Cytopathology, eval. of fine needle aspirate; interp. And report; technical component |
| $74.31 |
| 49 |
| EA |
| 1001Y |
| 88173-26 |
| Cytopathology, eval. of fine needle aspirate; interp; professional component |
| $71.44 |
| 1 |
| EA |
| 1001Z |
| 88182 |
| Cell Marker study |
| $126.37 |
| 1 |
| EA |
| 1001AA |
| 88184 |
| Flow Cytometry, cell, cytoplasmic, nuclear marker tech. only: first marker |
| $61.51 |
| 1 |
| EA |
| 1001AB |
| 88185 |
| Flow Cytometry, each additional marker, tech. only |
| $22.65 |
| 1 |
| EA |
| 1001AC |
| 88187 |
| Flow Cytometry, interpretation; 2 to 8 markers |
| $37.51 |
| 5 |
| EA |
| 1001AD |
| 88188 |
| Flow Cytometry, interpretation; 9 to 15 markers |
| $63.29 |
| 31 |
| EA |
| 1001AE |
| 88189 |
| Flow Cytometry, interpretation; 16 or more markers |
| $85.04 |
| 75 |
| EA |
| 1001AF |
| 88300 |
| Surg. Path., Gross Only, Level I; global |
| $14.82 |
| 18 |
| EA |
| 1001AG |
| 88300-TC |
| Surg. Path., Gross Only, Level I; technical component |
| $10.40 |
| 1 |
| EA |
| 1001AH |
| 88300-26 |
| Surg. Path., Gross Only, Level I; professional component |
| $4.42 |
| 1 |
| EA |
| 1001AI |
| 88302 |
| Surg. Path., Gross Only, Level II; global |
| $28.77 |
| 13 |
| EA |
| 1001AJ |
| 88302-TC |
| Surg. Path., Gross Only, Level II; technical component |
| $21.89 |
| 10 |
| EA |
| 1001AK |
| 88302-26 |
| Surg. Path., Gross Only, Level II; professional component |
| $6.88 |
| 1 |
| EA |
| 1001AL |
| 88304 |
| Surg. Path., Gross Only, Level III; global |
| $37.92 |
| 250 |
| EA |
| 1001AM |
| 88304-TC |
| Surg. Path., Gross Only, Level III; technical component |
| $26.49 |
| 30 |
| EA |
| 1001AN |
| 88304-26 |
| Surg. Path., Gross Only, Level III; professional component |
| $11.43 |
| 1 |
| EA |
| 1001AO |
| 88305 |
| Surg. Path., Gross Only, Level IV; global |
| $66.11 |
| 4114 |
| EA |
| 1001AP |
| 88305-TC |
| Surg. Path., Gross Only, Level IV; technical component |
| $27.80 |
| 451 |
| EA |
| 1001AQ |
| 88305-26 |
| Surg. Path., Gross Only, Level IV; professional component |
| $38.31 |
| 1 |
| EA |
| 1001AR |
| 88307 |
| Surg. Path., Gross Only, Level V; global |
| $253.65 |
| 145 |
| EA |
| 1001AS |
| 88307-TC |
| Surg. Path., Gross Only, Level V; technical component |
| $169.85 |
| 16 |
| EA |
| 1001AT |
| 88307-26 |
| Surg. Path., Gross Only, Level V; professional component |
| $83.80 |
| 1 |
| EA |
| 1001AU |
| 88309 |
| Surg. Path., Gross Only, Level IV; global |
| $386.46 |
| 24 |
| EA |
| 1001AV |
| 88309-TC |
| Surg. Path., Gross Only, Level IV; technical component |
| $238.37 |
| 3 |
| EA |
| 1001AW |
| 88309-26 |
| Surg. Path., Gross Only, Level IV; professional component |
| $148.10 |
| 1 |
| EA |
| 1001AX |
| 88311 |
| Decalcify Tissue; global |
| $20.58 |
| 90 |
| EA |
| 1001AY |
| 88311-TC |
| Decalcify Tissue; technical component |
| $8.10 |
| 9 |
| EA |
| 1001AZ |
| 88311-26 |
| Decalcify Tissue; professional component |
| $12.48 |
| 1 |
| EA |
| 1001BA |
| 88312 |
| Special Stains, Group I; global |
| $94.43 |
| 319 |
| EA |
| 1001BB |
| 88312-TC |
| Special Stains, Group I; technical component |
| $67.53 |
| 36 |
| EA |
| 1001BC |
| 88312-26 |
| Special Stains, Group I; professional component |
| $26.91 |
| 1 |
| EA |
| 1001BD |
| 88313 |
| Special Stains, Group II; global |
| $67.86 |
| 118 |
| EA |
| 1001BE |
| 88313-TC |
| Special Stains, Group II; technical component |
| $55.71 |
| 10 |
| EA |
| 1001BF |
| 88313-26 |
| Special Stains, Group II; professional component |
| $12.15 |
| 1 |
| EA |
| 1001BG |
| 88314 |
| Special Stains, Histochem. w/Frozen Section |
| $86.59 |
| 1 |
| EA |
| 1001BH |
| 88319 |
| Determinative histochemistry or cytochemistry to identify enzyme |
| $91.45 |
| 1 |
| EA |
| 1001BI |
| 88321 |
| Consultation and report on referred slides prepared elsewhere |
| $97.94 |
| 20 |
| EA |
| 1001BJ |
| 88323 |
| Consultation and report on referred material requiring preparation of slides |
| $113.13 |
| 1 |
| EA |
| 1001BK |
| 88325 |
| Consultation, comprehensive, review records with report |
| $175.75 |
| 1 |
| EA |
| 1001BL |
| 88329 |
| Pathology consultation during surgery |
| $49.98 |
| 1 |
| EA |
| 1001BM |
| 88331 |
| Pathology consultation during surgery first tissue block with frozen |
| $93.68 |
| 4 |
| EA |
| 1001BN |
| 88332 |
| Pathology consolation during surgery each additional tissue block with frozen |
| $51.25 |
| 6 |
| EA |
| 1001BO |
| 88333 |
| Pathology consolation during surgery cytologic exam (touch prep) initial |
| $86.49 |
| 1 |
| EA |
| 1001BP |
| 88334 |
| Pathology consolation during surgery cytologic exam (touch prep) initial |
| $54.00 |
| 1 |
| EA |
| 1001BQ |
| 88341 |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); global |
| $87.71 |
| 653 |
| EA |
| 1001BR |
| 88341-TC |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); technical component |
| $58.77 |
| 70 |
| EA |
| 1001BS |
| 88341-26 |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); professional component |
| $28.94 |
| 1 |
| EA |
| 1001BT |
| 88342 |
| Immunohistochemistry (including immunoperoxidase) each antibody; global |
| $100.75 |
| 201 |
| EA |
| 1001BU |
| 88342-TC |
| Immunohistochemistry (including immunoperoxidase) each antibody; technical component |
| $64.90 |
| 20 |
| EA |
| 1001BV |
| 88342-26 |
| Immunohistochemistry (including immunoperoxidase) each antibody; professional component |
| $35.85 |
| 1 |
| EA |
| 1001BW |
| 88346 |
| Immunofluorescent study, each antibody; direct method |
| $104.16 |
| 1 |
| EA |
| 1001BX |
| 88347 |
| Immunofluorescent study, each antibody; indirect method |
| $0.00 |
| 1 |
| EA |
| 1001BY |
| 88348 |
| Electron microscopy, diagnostic |
| $337.23 |
| 1 |
| EA |
| 1001BZ |
| 88360 |
| Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody, manual |
| $120.60 |
| 1 |
| EA |
| 1001CA |
| 88361 |
| M/PHMTRC ALYS TUM IMHCEM ANTB CPTB |
| $124.86 |
| 1 |
| EA |
| 1001CB |
| 88365 |
| SITU HYBRIDIZATIOHN EA PRB |
| $166.33 |
| 1 |
| EA |
| 1001CD |
| 88368 |
| M/PHMTRC ALYS ISH EA PRB MNL |
| $120.37 |
| 1 |
| EA |
Total CLIN 1001
Description
KEY PERSONNEL
CLIN
SUB-CLINs
.033 FTE Board Certified/Board Eligible Pathologist to perform on-site Pathology services
HR
Rank:
HR
Rank:
Total CLIN 1002
Estimated Period of Performance: OPTION 2: January 1, 2022 to December 31, 2022
CPT codes to be for Off-site services
Contract Line Item
| SUB-CLINs |
| CPT Code |
| Description |
| Medicare Geographic Rates (KS) |
| Estimated Amount |
| Unit |
| % Discount to the Medicare Geographic Rate |
| Total Price |
Pathology Current Procedural Terminology Off-site services
| 2001A |
| 80500 |
| Clinical pathology consultation; limited, without review of patient’s history and medical records. |
| $22.31 |
| 1 |
| EA |
| 2001B |
| 85060 |
| Blood Smear Interpretation with Report |
| $24.21 |
| 5 |
| EA |
| 2001C |
| 85097 |
| Bone Marrow; Smear Interpretation |
| $71.76 |
| 24 |
| EA |
| 2001D |
| 88104 |
| Cytopathology, fluids, except cervical & Vaginal; smears; global |
| $66.59 |
| 1 |
| EA |
| 2001E |
| 88104-TC |
| Cytopathology fluids, except cervical & Vaginal; smears; technical component |
| $37.98 |
| 1 |
| EA |
| 2001F |
| 88104-26 |
| Cytopathology, fluids, except cervical & Vaginal; smears; professional component |
| $28.61 |
| 1 |
| EA |
| 2001G |
| 88106 |
| Cytopathology, fluids, except cervical & Vaginal; filter |
| $60.40 |
| 1 |
| EA |
| 2001H |
| 88108 |
| Cytopathology, concentration technique, Smears & Interpret; global |
| $57.34 |
| 3 |
| EA |
| 2001I |
| 88108-TC |
| Cytopathology, concentration technique, Smears & Interpret; technical component |
| $34.69 |
| 3 |
| EA |
| 2001J |
| 88108-26 |
| Cytopathology, concentration technique, Smears & Interpret; professional component |
| $22.65 |
| 1 |
| EA |
| 2001K |
| 88112 |
| Cytopathology, liquid based slide preparation (SUREPATH); global |
| $63.96 |
| 20 |
| EA |
| 2001L |
| 88112-TC |
| Cytopathology, liquid based slide preparation (SUREPATH); technical component |
| $25.24 |
| 170 |
| EA |
| 2001M |
| 88112-26 |
| Cytopathology, liquid based slide preparation (SUREPATH); professional component |
| $30.68 |
| 1 |
| EA |
| 2001N |
| 88125 |
| Cytopathology, forensic (eg, sperm) |
| $0.00 |
| 1 |
| EA |
| 2001O |
| 88141 |
| Cytopathology; cervical or vaginal, interpretation by a physician; global |
| $0.00 |
| 25 |
| EA |
| 2001P |
| 88160 |
| Cytopathology; any other source, screen & interpretation; global |
| $67.38 |
| 1 |
| EA |
| 2001Q |
| 88160-TC |
| Cytopathology; any other source, screen & interpretation; technical component |
| $41.26 |
| 9 |
| EA |
| 2001R |
| 88160-26 |
| Cytopathology; any other source, screen & interpretation; professional component |
| $26.12 |
| 1 |
| EA |
| 2001S |
| 88161 |
| Cytopathology; any other source, preparation, screen & interp.; global |
| $62.79 |
| 1 |
| EA |
| 2001T |
| 88161-TC |
| Cytopathology; any other source, preparation, screen & interp.; technical component |
| $37.32 |
| 1 |
| EA |
| 2001U |
| 88161-26 |
| Cytopathology; any other source, preparation, screen & interp; professional component. |
| $25.46 |
| 1 |
| EA |
| 2001V |
| 88172 |
| Cytopathology, eval. of fine needle aspirate; deter. adequacy |
| $54.42 |
| 1 |
| EA |
| 2001W |
| 88173 |
| Cytopathology, eval. of fine needle aspirate; interp. And report; global |
| $145.76 |
| 6 |
| EA |
| 2001X |
| 88173-TC |
| Cytopathology, eval. of fine needle aspirate; interp. And report; technical component |
| $74.31 |
| 49 |
| EA |
| 2001Y |
| 88173-26 |
| Cytopathology, eval. of fine needle aspirate; interp; professional component |
| $71.44 |
| 1 |
| EA |
| 2001Z |
| 88182 |
| Cell Marker study |
| $126.37 |
| 1 |
| EA |
| 2001AA |
| 88184 |
| Flow Cytometry, cell, cytoplasmic, nuclear marker tech. only: first marker |
| $61.51 |
| 1 |
| EA |
| 2001AB |
| 88185 |
| Flow Cytometry, each additional marker, tech. only |
| $22.65 |
| 1 |
| EA |
| 2001AC |
| 88187 |
| Flow Cytometry, interpretation; 2 to 8 markers |
| $37.51 |
| 5 |
| EA |
| 2001AD |
| 88188 |
| Flow Cytometry, interpretation; 9 to 15 markers |
| $63.29 |
| 31 |
| EA |
| 2001AE |
| 88189 |
| Flow Cytometry, interpretation; 16 or more markers |
| $85.04 |
| 75 |
| EA |
| 2001AF |
| 88300 |
| Surg. Path., Gross Only, Level I; global |
| $14.82 |
| 18 |
| EA |
| 2001AG |
| 88300-TC |
| Surg. Path., Gross Only, Level I; technical component |
| $10.40 |
| 1 |
| EA |
| 2001AH |
| 88300-26 |
| Surg. Path., Gross Only, Level I; professional component |
| $4.42 |
| 1 |
| EA |
| 2001AI |
| 88302 |
| Surg. Path., Gross Only, Level II; global |
| $28.77 |
| 13 |
| EA |
| 2001AJ |
| 88302-TC |
| Surg. Path., Gross Only, Level II; technical component |
| $21.89 |
| 10 |
| EA |
| 2001AK |
| 88302-26 |
| Surg. Path., Gross Only, Level II; professional component |
| $6.88 |
| 1 |
| EA |
| 2001AL |
| 88304 |
| Surg. Path., Gross Only, Level III; global |
| $37.92 |
| 250 |
| EA |
| 2001AM |
| 88304-TC |
| Surg. Path., Gross Only, Level III; technical component |
| $26.49 |
| 30 |
| EA |
| 2001AN |
| 88304-26 |
| Surg. Path., Gross Only, Level III; professional component |
| $11.43 |
| 1 |
| EA |
| 2001AO |
| 88305 |
| Surg. Path., Gross Only, Level IV; global |
| $66.11 |
| 4114 |
| EA |
| 2001AP |
| 88305-TC |
| Surg. Path., Gross Only, Level IV; technical component |
| $27.80 |
| 451 |
| EA |
| 2001AQ |
| 88305-26 |
| Surg. Path., Gross Only, Level IV; professional component |
| $38.31 |
| 1 |
| EA |
| 2001AR |
| 88307 |
| Surg. Path., Gross Only, Level V; global |
| $253.65 |
| 145 |
| EA |
| 2001AS |
| 88307-TC |
| Surg. Path., Gross Only, Level V; technical component |
| $169.85 |
| 16 |
| EA |
| 2001AT |
| 88307-26 |
| Surg. Path., Gross Only, Level V; professional component |
| $83.80 |
| 1 |
| EA |
| 2001AU |
| 88309 |
| Surg. Path., Gross Only, Level IV; global |
| $386.46 |
| 24 |
| EA |
| 2001AV |
| 88309-TC |
| Surg. Path., Gross Only, Level IV; technical component |
| $238.37 |
| 3 |
| EA |
| 2001AW |
| 88309-26 |
| Surg. Path., Gross Only, Level IV; professional component |
| $148.10 |
| 1 |
| EA |
| 2001AX |
| 88311 |
| Decalcify Tissue; global |
| $20.58 |
| 90 |
| EA |
| 2001AY |
| 88311-TC |
| Decalcify Tissue; technical component |
| $8.10 |
| 9 |
| EA |
| 2001AZ |
| 88311-26 |
| Decalcify Tissue; professional component |
| $12.48 |
| 1 |
| EA |
| 2001BA |
| 88312 |
| Special Stains, Group I; global |
| $94.43 |
| 319 |
| EA |
| 2001BB |
| 88312-TC |
| Special Stains, Group I; technical component |
| $67.53 |
| 36 |
| EA |
| 2001BC |
| 88312-26 |
| Special Stains, Group I; professional component |
| $26.91 |
| 1 |
| EA |
| 2001BD |
| 88313 |
| Special Stains, Group II; global |
| $67.86 |
| 118 |
| EA |
| 2001BE |
| 88313-TC |
| Special Stains, Group II; technical component |
| $55.71 |
| 10 |
| EA |
| 2001BF |
| 88313-26 |
| Special Stains, Group II; professional component |
| $12.15 |
| 1 |
| EA |
| 2001BG |
| 88314 |
| Special Stains, Histochem. w/Frozen Section |
| $86.59 |
| 1 |
| EA |
| 2001BH |
| 88319 |
| Determinative histochemistry or cytochemistry to identify enzyme |
| $91.45 |
| 1 |
| EA |
| 2001BI |
| 88321 |
| Consultation and report on referred slides prepared elsewhere |
| $97.94 |
| 20 |
| EA |
| 2001BJ |
| 88323 |
| Consultation and report on referred material requiring preparation of slides |
| $113.13 |
| 1 |
| EA |
| 2001BK |
| 88325 |
| Consultation, comprehensive, review records with report |
| $175.75 |
| 1 |
| EA |
| 2001BL |
| 88329 |
| Pathology consultation during surgery |
| $49.98 |
| 1 |
| EA |
| 2001BM |
| 88331 |
| Pathology consultation during surgery first tissue block with frozen |
| $93.68 |
| 4 |
| EA |
| 2001BN |
| 88332 |
| Pathology consolation during surgery each additional tissue block with frozen |
| $51.25 |
| 6 |
| EA |
| 2001BO |
| 88333 |
| Pathology consolation during surgery cytologic exam (touch prep) initial |
| $86.49 |
| 1 |
| EA |
| 2001BP |
| 88334 |
| Pathology consolation during surgery cytologic exam (touch prep) initial |
| $54.00 |
| 1 |
| EA |
| 2001BQ |
| 88341 |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); global |
| $87.71 |
| 653 |
| EA |
| 2001BR |
| 88341-TC |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); technical component |
| $58.77 |
| 70 |
| EA |
| 2001BS |
| 88341-26 |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); professional component |
| $28.94 |
| 1 |
| EA |
| 2001BT |
| 88342 |
| Immunohistochemistry (including immunoperoxidase) each antibody; global |
| $100.75 |
| 201 |
| EA |
| 2001BU |
| 88342-TC |
| Immunohistochemistry (including immunoperoxidase) each antibody; technical component |
| $64.90 |
| 20 |
| EA |
| 2001BV |
| 88342-26 |
| Immunohistochemistry (including immunoperoxidase) each antibody; professional component |
| $35.85 |
| 1 |
| EA |
| 2001BW |
| 88346 |
| Immunofluorescent study, each antibody; direct method |
| $104.16 |
| 1 |
| EA |
| 2001BX |
| 88347 |
| Immunofluorescent study, each antibody; indirect method |
| $0.00 |
| 1 |
| EA |
| 2001BY |
| 88348 |
| Electron microscopy, diagnostic |
| $337.23 |
| 1 |
| EA |
| 2001BZ |
| 88360 |
| Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody, manual |
| $120.60 |
| 1 |
| EA |
| 2001CA |
| 88361 |
| Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, per specimen, each single antibody stain procedure |
| $124.86 |
| 1 |
| EA |
| 2001CB |
| 88365 |
| SITU hybridization ea PRB |
| $166.33 |
| 1 |
| EA |
| 2001CD |
| 88368 |
| M/PHMTRC ALYS ISH EA PRB MNL |
| $120.37 |
| 1 |
| EA |
Total CLIN 2001
Description
CLIN
.033 FTE Board Certified/Board Eligible Pathologist to perform on-site Pathology services
KEY PERSONNEL
HR
Rank
HR
Rank
Total CLIN 2002
HR
Estimated Period of Performance: OPTION 3: January 1, 2023 to December 31, 2023
CPT codes to be for Off-site services
Contract Line Item
| SUB-CLINs |
| CPT Code |
| Description |
| Medicare Geographic Rates (KS) |
Estimated Amount
| Unit |
| % Discount to the Medicare Geographic Rate |
| Total Price |
Pathology Current Procedural Terminology Off-site services
| 3001A |
| 80500 |
| Clinical pathology consultation; limited, without review of patient’s history and medical records. |
| $22.31 |
| 5 |
| EA |
| 3001B |
| 85060 |
| Blood Smear Interpretation with Report |
| $24.21 |
| 24 |
| EA |
| 3001C |
| 85097 |
| Bone Marrow; Smear Interpretation |
| $71.76 |
| 1 |
| EA |
| 3001D |
| 88104 |
| Cytopathology, fluids, except cervical & Vaginal; smears; global |
| $66.59 |
| 1 |
| EA |
| 3001E |
| 88104-TC |
| Cytopathology fluids, except cervical & Vaginal; smears; technical component |
| $37.98 |
| 1 |
| EA |
| 3001F |
| 88104-26 |
| Cytopathology, fluids, except cervical & Vaginal; smears; professional component |
| $28.61 |
| 1 |
| EA |
| 3001G |
| 88106 |
| Cytopathology, fluids, except cervical & Vaginal; filter |
| $60.40 |
| 3 |
| EA |
| 3001H |
| 88108 |
| Cytopathology, concentration technique, Smears & Interpret; global |
| $57.34 |
| 3 |
| EA |
| 3001I |
| 88108-TC |
| Cytopathology, concentration technique, Smears & Interpret; technical component |
| $34.69 |
| 1 |
| EA |
| 3001J |
| 88108-26 |
| Cytopathology, concentration technique, Smears & Interpret; professional component |
| $22.65 |
| 20 |
| EA |
| 3001K |
| 88112 |
| Cytopathology, liquid based slide preparation (SUREPATH); global |
| $63.96 |
| 170 |
| EA |
| 3001L |
| 88112-TC |
| Cytopathology, liquid based slide preparation (SUREPATH); technical component |
| $25.24 |
| 1 |
| EA |
| 3001M |
| 88112-26 |
| Cytopathology, liquid based slide preparation (SUREPATH); professional component |
| $30.68 |
| 1 |
| EA |
| 3001N |
| 88125 |
| Cytopathology, forensic (eg, sperm) |
| $0.00 |
| 25 |
| EA |
| 3001O |
| 88141 |
| Cytopathology; cervical or vaginal, interpretation by a physician; global |
| $0.00 |
| 1 |
| EA |
| 3001P |
| 88160 |
| Cytopathology; any other source, screen & interpretation; global |
| $67.38 |
| 9 |
| EA |
| 3001Q |
| 88160-TC |
| Cytopathology; any other source, screen & interpretation; technical component |
| $41.26 |
| 1 |
| EA |
| 3001R |
| 88160-26 |
| Cytopathology; any other source, screen & interpretation; professional component |
| $26.12 |
| 1 |
| EA |
| 3001S |
| 88161 |
| Cytopathology; any other source, preparation, screen & interp.; global |
| $62.79 |
| 1 |
| EA |
| 3001T |
| 88161-TC |
| Cytopathology; any other source, preparation, screen & interp.; technical component |
| $37.32 |
| 1 |
| EA |
| 3001U |
| 88161-26 |
| Cytopathology; any other source, preparation, screen & interp; professional component. |
| $25.46 |
| 1 |
| EA |
| 3001V |
| 88172 |
| Cytopathology, eval. of fine needle aspirate; deter. adequacy |
| $54.42 |
| 6 |
| EA |
| 3001W |
| 88173 |
| Cytopathology, eval. of fine needle aspirate; interp. And report; global |
| $145.76 |
| 49 |
| EA |
| 3001X |
| 88173-TC |
| Cytopathology, eval. of fine needle aspirate; interp. And report; technical component |
| $74.31 |
| 1 |
| EA |
| 3001Y |
| 88173-26 |
| Cytopathology, eval. of fine needle aspirate; interp; professional component |
| $71.44 |
| 1 |
| EA |
| 3001Z |
| 88182 |
| Cell Marker study |
| $126.37 |
| 1 |
| EA |
| 3001AA |
| 88184 |
| Flow Cytometry, cell, cytoplasmic, nuclear marker tech. only: first marker |
| $61.51 |
| 1 |
| EA |
| 3001AB |
| 88185 |
| Flow Cytometry, each additional marker, tech. only |
| $22.65 |
| 5 |
| EA |
| 3001AC |
| 88187 |
| Flow Cytometry, interpretation; 2 to 8 markers |
| $37.51 |
| 31 |
| EA |
| 3001AD |
| 88188 |
| Flow Cytometry, interpretation; 9 to 15 markers |
| $63.29 |
| 75 |
| EA |
| 3001AE |
| 88189 |
| Flow Cytometry, interpretation; 16 or more markers |
| $85.04 |
| 18 |
| EA |
| 3001AF |
| 88300 |
| Surg. Path., Gross Only, Level I; global |
| $14.82 |
| 1 |
| EA |
| 3001AG |
| 88300-TC |
| Surg. Path., Gross Only, Level I; technical component |
| $10.40 |
| 1 |
| EA |
| 3001AH |
| 88300-26 |
| Surg. Path., Gross Only, Level I; professional component |
| $4.42 |
| 13 |
| EA |
| 3001AI |
| 88302 |
| Surg. Path., Gross Only, Level II; global |
| $28.77 |
| 10 |
| EA |
| 3001AJ |
| 88302-TC |
| Surg. Path., Gross Only, Level II; technical component |
| $21.89 |
| 1 |
| EA |
| 3001AK |
| 88302-26 |
| Surg. Path., Gross Only, Level II; professional component |
| $6.88 |
| 250 |
| EA |
| 3001AL |
| 88304 |
| Surg. Path., Gross Only, Level III; global |
| $37.92 |
| 30 |
| EA |
| 3001AM |
| 88304-TC |
| Surg. Path., Gross Only, Level III; technical component |
| $26.49 |
| 1 |
| EA |
| 3001AN |
| 88304-26 |
| Surg. Path., Gross Only, Level III; professional component |
| $11.43 |
| 4114 |
| EA |
| 3001AO |
| 88305 |
| Surg. Path., Gross Only, Level IV; global |
| $66.11 |
| 451 |
| EA |
| 3001AP |
| 88305-TC |
| Surg. Path., Gross Only, Level IV; technical component |
| $27.80 |
| 1 |
| EA |
| 3001AQ |
| 88305-26 |
| Surg. Path., Gross Only, Level IV; professional component |
| $38.31 |
| 145 |
| EA |
| 3001AR |
| 88307 |
| Surg. Path., Gross Only, Level V; global |
| $253.65 |
| 16 |
| EA |
| 3001AS |
| 88307-TC |
| Surg. Path., Gross Only, Level V; technical component |
| $169.85 |
| 1 |
| EA |
| 3001AT |
| 88307-26 |
| Surg. Path., Gross Only, Level V; professional component |
| $83.80 |
| 24 |
| EA |
| 3001AU |
| 88309 |
| Surg. Path., Gross Only, Level IV; global |
| $386.46 |
| 3 |
| EA |
| 3001AV |
| 88309-TC |
| Surg. Path., Gross Only, Level IV; technical component |
| $238.37 |
| 1 |
| EA |
| 3001AW |
| 88309-26 |
| Surg. Path., Gross Only, Level IV; professional component |
| $148.10 |
| 90 |
| EA |
| 3001AX |
| 88311 |
| Decalcify Tissue; global |
| $20.58 |
| 9 |
| EA |
| 3001AY |
| 88311-TC |
| Decalcify Tissue; technical component |
| $8.10 |
| 1 |
| EA |
| 3001AZ |
| 88311-26 |
| Decalcify Tissue; professional component |
| $12.48 |
| 319 |
| EA |
| 3001BA |
| 88312 |
| Special Stains, Group I; global |
| $94.43 |
| 36 |
| EA |
| 3001BB |
| 88312-TC |
| Special Stains, Group I; technical component |
| $67.53 |
| 1 |
| EA |
| 3001BC |
| 88312-26 |
| Special Stains, Group I; professional component |
| $26.91 |
| 118 |
| EA |
3001BD
| 88313 |
| Special Stains, Group II; global |
| $67.86 |
| 10 |
| EA |
| 3001BE |
| 88313-TC |
| Special Stains, Group II; technical component |
| $55.71 |
| 1 |
| EA |
| 3001BF |
| 88313-26 |
| Special Stains, Group II; professional component |
| $12.15 |
| 1 |
| EA |
| 3001BG |
| 88314 |
| Special Stains, Histochem. w/Frozen Section |
| $86.59 |
| 1 |
| EA |
| 3001BH |
| 88319 |
| Determinative histochemistry or cytochemistry to identify enzyme |
| $91.45 |
| 20 |
| EA |
| 3001BI |
| 88321 |
| Consultation and report on referred slides prepared elsewhere |
| $97.94 |
| 1 |
| EA |
| 3001BJ |
| 88323 |
| Consultation and report on referred material requiring preparation of slides |
| $113.13 |
| 1 |
| EA |
| 3001BK |
| 88325 |
| Consultation, comprehensive, review records with report |
| $175.75 |
| 1 |
| EA |
| 3001BL |
| 88329 |
| Pathology consultation during surgery |
| $49.98 |
| 4 |
| EA |
| 3001BM |
| 88331 |
| Pathology consultation during surgery first tissue block with frozen |
| $93.68 |
| 6 |
| EA |
| 3001BN |
| 88332 |
| Pathology consolation during surgery each additional tissue block with frozen |
| $51.25 |
| 1 |
| EA |
| 3001BO |
| 88333 |
| Pathology consolation during surgery cytologic exam (touch prep) initial |
| $86.49 |
| 1 |
| EA |
| 3001BP |
| 88334 |
| Pathology consolation during surgery cytologic exam (touch prep) initial |
| $54.00 |
| 653 |
| EA |
| 3001BQ |
| 88341 |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); global |
| $87.71 |
| 70 |
| EA |
| 3001BR |
| 88341-TC |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); technical component |
| $58.77 |
| 1 |
| EA |
| 3001BS |
| 88341-26 |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); professional component |
| $28.94 |
| 201 |
| EA |
| 3001BT |
| 88342 |
| Immunohistochemistry (including immunoperoxidase) each antibody; global |
| $100.75 |
| 20 |
| EA |
| 3001BU |
| 88342-TC |
| Immunohistochemistry (including immunoperoxidase) each antibody; technical component |
| $64.90 |
| 1 |
| EA |
| 3001BV |
| 88342-26 |
| Immunohistochemistry (including immunoperoxidase) each antibody; professional component |
| $35.85 |
| 1 |
| EA |
| 3001BW |
| 88346 |
| Immunofluorescent study, each antibody; direct method |
| $104.16 |
| 1 |
| EA |
| 3001BX |
| 88347 |
| Immunofluorescent study, each antibody; indirect method |
| $0.00 |
| 1 |
| EA |
| 3001BY |
| 88348 |
| Electron microscopy, diagnostic |
| $337.23 |
| 1 |
| EA |
| 3001BZ |
| 88360 |
| Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody, manual |
| $120.60 |
| 1 |
| EA |
| 3001CA |
| 88361 |
| Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, per specimen, each single antibody stain procedure |
| $124.86 |
| 1 |
| EA |
| 3001CB |
| 88365 |
| SITU hybridization ea PRB |
| $166.33 |
| 1 |
| EA |
| 3001CD |
| 88368 |
| M/PHMTRC ALYS ISH EA PRB MNL |
| $120.37 |
| 5 |
| EA |
Total CLIN 3001
On-site Services
CLIN
.033 FTE Board Certified/Board Eligible Pathologist to perform on-site Pathology services
KEY PERSONNEL
HR
Rank:
HR
Rank:
Total CLIN 3002
HR
Estimated Period of Performance: OPTION 4: January 1, 2024 to December 31, 2024
CPT codes to be for Off-site services
Contract Line Item
| SUB-CLINs |
| CPT Code |
| Description |
| Medicare Geographic Rates (KS) |
Unit
Estimated Amount
| % Discount to the Medicare Geographic Rate |
| Total Price |
Pathology Current Procedural Terminology Off-site services
| 4001A |
| 80500 |
| Clinical pathology consultation; limited, without review of patient’s history and medical records. |
| $22.31 |
| 5 |
| EA |
| 4001B |
| 85060 |
| Blood Smear Interpretation with Report |
| $24.21 |
| 24 |
| EA |
| 4001C |
| 85097 |
| Bone Marrow; Smear Interpretation |
| $71.76 |
| 1 |
| EA |
| 4001D |
| 88104 |
| Cytopathology, fluids, except cervical & Vaginal; smears; global |
| $66.59 |
| 1 |
| EA |
| 4001E |
| 88104-TC |
| Cytopathology fluids, except cervical & Vaginal; smears; technical component |
| $37.98 |
| 1 |
| EA |
| 4001F |
| 88104-26 |
| Cytopathology, fluids, except cervical & Vaginal; smears; professional component |
| $28.61 |
| 1 |
| EA |
| 4001G |
| 88106 |
| Cytopathology, fluids, except cervical & Vaginal; filter |
| $60.40 |
| 3 |
| EA |
| 4001H |
| 88108 |
| Cytopathology, concentration technique, Smears & Interpret; global |
| $57.34 |
| 3 |
| EA |
| 4001I |
| 88108-TC |
| Cytopathology, concentration technique, Smears & Interpret; technical component |
| $34.69 |
| 1 |
| EA |
| 4001J |
| 88108-26 |
| Cytopathology, concentration technique, Smears & Interpret; professional component |
| $22.65 |
| 20 |
| EA |
| 4001K |
| 88112 |
| Cytopathology, liquid based slide preparation (SUREPATH); global |
| $63.96 |
| 170 |
| EA |
| 4001L |
| 88112-TC |
| Cytopathology, liquid based slide preparation (SUREPATH); technical component |
| $25.24 |
| 1 |
| EA |
| 4001M |
| 88112-26 |
| Cytopathology, liquid based slide preparation (SUREPATH); professional component |
| $30.68 |
| 1 |
| EA |
| 4001N |
| 88125 |
| Cytopathology, forensic (eg, sperm) |
| $0.00 |
| 25 |
| EA |
| 4001O |
| 88141 |
| Cytopathology; cervical or vaginal, interpretation by a physician; global |
| $0.00 |
| 1 |
| EA |
| 4001P |
| 88160 |
| Cytopathology; any other source, screen & interpretation; global |
| $67.38 |
| 9 |
| EA |
| 4001Q |
| 88160-TC |
| Cytopathology; any other source, screen & interpretation; technical component |
| $41.26 |
| 1 |
| EA |
| 4001R |
| 88160-26 |
| Cytopathology; any other source, screen & interpretation; professional component |
| $26.12 |
| 1 |
| EA |
| 4001S |
| 88161 |
| Cytopathology; any other source, preparation, screen & interp.; global |
| $62.79 |
| 1 |
| EA |
| 4001T |
| 88161-TC |
| Cytopathology; any other source, preparation, screen & interp.; technical component |
| $37.32 |
| 1 |
| EA |
| 4001U |
| 88161-26 |
| Cytopathology; any other source, preparation, screen & interp; professional component. |
| $25.46 |
| 1 |
| EA |
| 4001V |
| 88172 |
| Cytopathology, eval. of fine needle aspirate; deter. adequacy |
| $54.42 |
| 6 |
| EA |
| 4001W |
| 88173 |
| Cytopathology, eval. of fine needle aspirate; interp. And report; global |
| $145.76 |
| 49 |
| EA |
| 4001X |
| 88173-TC |
| Cytopathology, eval. of fine needle aspirate; interp. And report; technical component |
| $74.31 |
| 1 |
| EA |
| 4001Y |
| 88173-26 |
| Cytopathology, eval. of fine needle aspirate; interp; professional component |
| $71.44 |
| 1 |
| EA |
| 4001Z |
| 88182 |
| Cell Marker study |
| $126.37 |
| 1 |
| EA |
| 4001AA |
| 88184 |
| Flow Cytometry, cell, cytoplasmic, nuclear marker tech. only: first marker |
| $61.51 |
| 1 |
| EA |
| 4001AB |
| 88185 |
| Flow Cytometry, each additional marker, tech. only |
| $22.65 |
| 5 |
| EA |
| 4001AC |
| 88187 |
| Flow Cytometry, interpretation; 2 to 8 markers |
| $37.51 |
| 31 |
| EA |
| 4001AD |
| 88188 |
| Flow Cytometry, interpretation; 9 to 15 markers |
| $63.29 |
| 75 |
| EA |
| 4001AE |
| 88189 |
| Flow Cytometry, interpretation; 16 or more markers |
| $85.04 |
| 18 |
| EA |
| 4001AF |
| 88300 |
| Surg. Path., Gross Only, Level I; global |
| $14.82 |
| 1 |
| EA |
| 4001AG |
| 88300-TC |
| Surg. Path., Gross Only, Level I; technical component |
| $10.40 |
| 1 |
| EA |
| 4001AH |
| 88300-26 |
| Surg. Path., Gross Only, Level I; professional component |
| $4.42 |
| 13 |
| EA |
| 4001AI |
| 88302 |
| Surg. Path., Gross Only, Level II; global |
| $28.77 |
| 10 |
| EA |
| 4001AJ |
| 88302-TC |
| Surg. Path., Gross Only, Level II; technical component |
| $21.89 |
| 1 |
| EA |
| 4001AK |
| 88302-26 |
| Surg. Path., Gross Only, Level II; professional component |
| $6.88 |
| 250 |
| EA |
| 4001AL |
| 88304 |
| Surg. Path., Gross Only, Level III; global |
| $37.92 |
| 30 |
| EA |
| 4001AM |
| 88304-TC |
| Surg. Path., Gross Only, Level III; technical component |
| $26.49 |
| 1 |
| EA |
| 4001AN |
| 88304-26 |
| Surg. Path., Gross Only, Level III; professional component |
| $11.43 |
| 4114 |
| EA |
| 4001AO |
| 88305 |
| Surg. Path., Gross Only, Level IV; global |
| $66.11 |
| 451 |
| EA |
| 4001AP |
| 88305-TC |
| Surg. Path., Gross Only, Level IV; technical component |
| $27.80 |
| 1 |
| EA |
| 4001AQ |
| 88305-26 |
| Surg. Path., Gross Only, Level IV; professional component |
| $38.31 |
| 145 |
| EA |
| 4001AR |
| 88307 |
| Surg. Path., Gross Only, Level V; global |
| $253.65 |
| 16 |
| EA |
| 4001AS |
| 88307-TC |
| Surg. Path., Gross Only, Level V; technical component |
| $169.85 |
| 1 |
| EA |
| 4001AT |
| 88307-26 |
| Surg. Path., Gross Only, Level V; professional component |
| $83.80 |
| 24 |
| EA |
| 4001AU |
| 88309 |
| Surg. Path., Gross Only, Level IV; global |
| $386.46 |
| 3 |
| EA |
| 4001AV |
| 88309-TC |
| Surg. Path., Gross Only, Level IV; technical component |
| $238.37 |
| 1 |
| EA |
| 4001AW |
| 88309-26 |
| Surg. Path., Gross Only, Level IV; professional component |
| $148.10 |
| 90 |
| EA |
| 4001AX |
| 88311 |
| Decalcify Tissue; global |
| $20.58 |
| 9 |
| EA |
| 4001AY |
| 88311-TC |
| Decalcify Tissue; technical component |
| $8.10 |
| 1 |
| EA |
| 4001AZ |
| 88311-26 |
| Decalcify Tissue; professional component |
| $12.48 |
| 319 |
| EA |
| 4001BA |
| 88312 |
| Special Stains, Group I; global |
| $94.43 |
| 36 |
| EA |
| 4001BB |
| 88312-TC |
| Special Stains, Group I; technical component |
| $67.53 |
| 1 |
| EA |
| 4001BC |
| 88312-26 |
| Special Stains, Group I; professional component |
| $26.91 |
| 118 |
| EA |
| 4001BD |
| 88313 |
| Special Stains, Group II; global |
| $67.86 |
| 10 |
| EA |
| 4001BE |
| 88313-TC |
| Special Stains, Group II; technical component |
| $55.71 |
| 1 |
| EA |
| 4001BF |
| 88313-26 |
| Special Stains, Group II; professional component |
| $12.15 |
| 1 |
| EA |
| 4001BG |
| 88314 |
| Special Stains, Histochem. w/Frozen Section |
| $86.59 |
| 1 |
| EA |
| 4001BH |
| 88319 |
| Determinative histochemistry or cytochemistry to identify enzyme |
| $91.45 |
| 20 |
| EA |
| 4001BI |
| 88321 |
| Consultation and report on referred slides prepared elsewhere |
| $97.94 |
| 1 |
| EA |
| 4001BJ |
| 88323 |
| Consultation and report on referred material requiring preparation of slides |
| $113.13 |
| 1 |
| EA |
| 4001BK |
| 88325 |
| Consultation, comprehensive, review records with report |
| $175.75 |
| 1 |
| EA |
| 4001BL |
| 88329 |
| Pathology consultation during surgery |
| $49.98 |
| 4 |
| EA |
| 4001BM |
| 88331 |
| Pathology consultation during surgery first tissue block with frozen |
| $93.68 |
| 6 |
| EA |
| 4001BN |
| 88332 |
| Pathology consolation during surgery each additional tissue block with frozen |
| $51.25 |
| 1 |
| EA |
| 4001BO |
| 88333 |
| Pathology consolation during surgery cytologic exam (touch prep) initial |
| $86.49 |
| 1 |
| EA |
| 4001BP |
| 88334 |
| Pathology consolation during surgery cytologic exam (touch prep) initial |
| $54.00 |
| 653 |
| EA |
| 4001BQ |
| 88341 |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); global |
| $87.71 |
| 70 |
| EA |
| 4001BR |
| 88341-TC |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); technical component |
| $58.77 |
| 1 |
| EA |
| 4001BS |
| 88341-26 |
| Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); professional component |
| $28.94 |
| 201 |
| EA |
| 4001BT |
| 88342 |
| Immunohistochemistry (including immunoperoxidase) each antibody; global |
| $100.75 |
| 20 |
| EA |
| 4001BU |
| 88342-TC |
| Immunohistochemistry (including immunoperoxidase) each antibody; technical component |
| $64.90 |
| 1 |
| EA |
| 4001BV |
| 88342-26 |
| Immunohistochemistry (including immunoperoxidase) each antibody; professional component |
| $35.85 |
| 1 |
| EA |
| 4001BW |
| 88346 |
| Immunofluorescent study, each antibody; direct method |
| $104.16 |
| 1 |
| EA |
| 4001BX |
| 88347 |
| Immunofluorescent study, each antibody; indirect method |
| $0.00 |
| 1 |
| EA |
| 4001BY |
| 88348 |
| Electron microscopy, diagnostic |
| $337.23 |
| 1 |
| EA |
| 4001BZ |
| 88360 |
| Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody, manual |
| $120.60 |
| 1 |
| EA |
| 4001CA |
| 88361 |
| Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, per specimen, each single antibody stain procedure |
| $124.86 |
| 1 |
| EA |
| 4001CB |
| 88365 |
| SITU hybridization ea PRB |
| $166.33 |
| 1 |
| EA |
| 4001CD |
| 88368 |
| M/PHMTRC ALYS ISH EA PRB MNL |
| $120.37 |
| 1 |
| EA |
Total CLIN 4001
On-site Services
CLIN
.033 FTE Board Certified/Board Eligible Pathologist to perform on-site Pathology Services
KEY PERSONNEL
HR
Rank:
HR
Rank:
Estimated total for Base year $_______________________
Estimated total for Option Year 1 $_______________________
Estimated total for Option Year 2 $_______________________
Estimated total for Option…
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