36C26319R0139-006.xlsx
XLSX spreadsheet 48 KB Posted
- Attached to
- Specialized Laboratory Testing and Consultation Services Federal contract opportunity
- Solicitation number
- 36C26319R0139
About this file
36C26319R0139 D.5 - Attachment 5 - Schedule of Items - Pricing.xlsx
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C26319R0139-004.pdf | ||
| 36C26319R0139-002.pdf | ||
| 36C26319R0139-005.pdf | ||
| 36C26319R0139-001.docx | DOCX document | |
| 36C26319R0139-003.pdf | ||
| 36C26319R0139-000.docx | DOCX document |
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Summary Summary Schedule of Items
| Extended Pricing | |
| Base Year | ERROR:#REF! |
| Option Year I | ERROR:#REF! |
| Option Year II | ERROR:#REF! |
| Option Year III | ERROR:#REF! |
| Option Year 4 | $ - 0 |
Total Offer Price ERROR:#REF!
Base Period
ATTACHMENT 5 - SCHEDULE OF ITEMS - PRICING
| BASE PERIOD | ||
| DESCRIPTION | Base Period |
Estimated volume Base Period
Unit Price
(OFFEROR TO COMPLETE) Base Period
Estimated Total Price
(OFFEROR TO COMPLETE)
| CLIN | REFERENCE CPT CODE(S) | Specialized Laboratory and Consultation Services | |||
| 1 | 84311 | Adenosine Deaminase, Pericardial | 2 | ||
| 2 | 80150 | Amikacin Level | 4 | ||
| 3 | 80335 | Amitriptyline/Nortriptyline | 4 | ||
| 4 | 86334 | Beta-2 Transferrin | 5 | ||
| 5 | 81370 | HLA ABDssop (BMT HLA DR/DQ) Panel | 25 | ||
| 6 | 81376 (x3) | HLA-LowRes Class II 1 Loci | 25 | ||
| 7 | 86162 | Complement CH50, Total | 35 | ||
| 8 | 82595 | Cryoglobulin, Quantitative | 160 | ||
| 9 | 86334 | Cryoglobulin Identification | 51 | ||
| 10 | 80158 | Cyclosporin | 145 | ||
| 11 | 80169 | Everolimus | 15 | ||
| 12 | 83520 | Granulocyte Colony Stimulating Factor | 2 | ||
| 13 | 83520 | Granulocyte Macrophage CS Factor | 2 | ||
| 14 | 86828 | HLA PRA (Screen) | 2 | ||
| 15 | 86832 | HLA PRA (Class 1) | 2 | ||
| 16 | 86833 | HLA PRA (Class 2) | 2 | ||
| 17 | 80299 | Methotrexate | 45 | ||
| 18 | 82657 | Porphobilinogen Deaminase, RBC | 2 | ||
| 19 | 80188 | Primidone | 5 | ||
| 20 | 80192 | Procainamide & N-Acetylprocainamide (NAPA) | 4 | ||
| 21 | 80194 | Quinidine | 2 | ||
| 22 | 80195 | Sirolimus | 40 | ||
| 23 | 80299 | Sulfonylurea Screen | 4 | ||
| 24 | 80197 | Tacrolimus | 700 | ||
| 25 | 80200 | Tobramycin | 15 | ||
| 26 | 82710 | Fat, Feces, Quantitative, Timed Collection | 15 | ||
| 27 | 82705 | Fat, Feces, Quantitative, Ramdom Collection | 10 | ||
| 28 | 85307 | Activated Protein C | 3 | ||
| 29 | 85379 | D-Dimer, Quantitative | 1 | ||
| 30 | 85260 | Factor 10, Chromogenic | 25 | ||
| 31 | 85270 | Factor 11 Activity | 1 | ||
| 32 | 85280 | Factor 12 Activity | 1 | ||
| 33 | 85240 | Factor 8 Activity | 1 | ||
| 34 | 85250 | Factor 9 Activity | 1 | ||
| 35 | 85210 | Factor 2 Activity | 1 | ||
| 36 | 85220 | Factor 5 Activity | 1 | ||
| 37 | 85230 | Factor 7 Activity | 1 | ||
| 38 | 85260 | Factor 10 Activity | 1 | ||
| 39 | 85384 | Fibrinogen Activity | 1 | ||
| 40 | 85520 | Arixtra (Fondaparinux) Assay | 5 | ||
| 41 | 86022 | Heparin Induced Thrombocytopenia | 1 | ||
| 42 | 85520 | Heparin (10a) Level | 1 | ||
| 43 | 85730 (PTT) | Lupus Anticoagulant Panel | 1 | ||
| 44 | 85732 (PTT Mix) | Partial Thromboplastin Time (PTT) Mixing Study | 1 | ||
| 45 | 85597 (PLTNEU) | Platelet Neurtralization | 1 | ||
| 46 | 85613 (DRVVT Screen) | Dilute Russell's viper Venom time (dRVVT) Screen | 1 | ||
| 47 | 85613 (DRVVT Mix) | Dilute Russell's viper Venom time (dRVVT) Mix | 1 | ||
| 48 | 85613 (DRVVT Confirm) | Dilute Russell's viper Venom time (dRVVT) Confirmation | 1 | ||
| 49 | 85525 (Hepzyme if required) | Hepzyme inhibitor to be used as needed to determine heparin contamination | 1 | ||
| 50 | 85420 | Plasminogen Activity | 1 | ||
| 51 | 85576 | Platelet Aggregation Tests | 1 | ||
| 52 | 85576 Col/EPI | Platelet Function Closure Time | 15 | ||
| 53 | 85576 Col/ADP if performed | Reflex: Platelet Function Closure Time ADP | 10 | ||
| 54 | 85730 | Partial Thromboplastin Time (PTT) | 1 | ||
| 55 | 85610 | Protime/INR | 3 | ||
| 56 | 85670 | Thrombin Time | 1 | ||
| 57 | 85576 | Platelet Function P2Y12 (Verify Now) | 1 | ||
| 58 | 85335 (Bethesda assay) | Bethesda Assay for Factor 8 with Normal Plasma | 1 | ||
| 59 | 85335 (Bethesda assay) | Bethesda Assay for Factor 9 with Normal Plasma | 1 | ||
| 60 | 87801 | Bordetella pertussis/parapertussis PCR | 22 | ||
| 61 | 87496 | Cytomegalovirus qual PCR (CSF) | 12 | ||
| 62 | 87496 | Cytomegalovirus qual PCR (Bone Marrow) | 118 | ||
| 63 | 87497 | Cytomegalovirus quantitative PCR | 1 | ||
| 64 | 87498 | Enterovirus PCR (CSF) | 10 | ||
| 65 | 87799 | Epstein-Barr Virus PCR | 12 | ||
| 66 | 87529x2 | Herpes Simplex Culture w/typing test | 6 | ||
| 67 | 87529x2 | Herpes Simplex Virus PCR test (CSF) | 20 | ||
| 68 | Influenza A & B culture and rapid test | 8 | |||
| 69 | 87109 | Mycoplasma Culture test | 3 | ||
| 70 | 87109 | Ureaplasma culture test | 3 | ||
| 71 | 87633 | Respiratory Virus Panel test (PCR, extended) | 8 | ||
| 72 | 87798 | Varicella-Zoster Virus PCR test - non blood | 22 | ||
| 73 | 87252 | Viral Culture-Non-Respiratory | 100 | ||
| 74 | 87253 | Viral Culture-Non-Respiratory Reflex to ID | 100 | ||
| 75 | 87252 | Viral Culture-Respiratory | 100 | ||
| 76 | 87253 | Viral Culture-Respiratory | 100 | ||
| 77 | 87798 | Varicella-Zoster Virus PCR test Qualitative (Blood) | 10 | ||
| 78 | 87254 | Viral Culture, Rapid Resipratory | 180 | ||
| 79 | Fondaparinux | 1 | |||
| 80 | Stat Fondaparinux (Additional $200 for stat) | 1 | |||
| 81 | 87624 | Human Papillomavirus Detection HPVMD | 5 | ||
| 82 | 88342 | TC initial, ImmunohistoChemistry stain | 7 | ||
| 83 | 88343 | TC additional, ImmunohistoChemistry stain | 7 | ||
| 84 | Neuropathological Gross Exam | 4 | |||
| 85 | 88312 | Organism Stain (group 1) | 5 | ||
| 86 | 88312-26 | Organism Stain , interp. | 1 | ||
| 87 | 88313 | Organism Stain (group 2) | 5 | ||
| 88 | 88313-26 | Organism Stain (group 2), interp. | 1 | ||
| 89 | 88323 | Path block consult PC | 1 | ||
| 90 | 88323 | Path Consult & Report w/slide prep | 4 | ||
| 91 | 88321 | Path Consult & Report, Outside Cases (Brains) | 5 | ||
| 92 | 88321 | Revuew Outside Slides Pro Free | 1 | ||
| 93 | 6051014 | Doctor Neuropatholgy Autopsies | 50 | ||
| 94 | 88231 | Specialized Consulti with Dr. Snover specifically - Review outside slides (TC & PF Charges) | 4 | ||
| 95 | 88235 | Path Comprehensive Consult with Dr. Snover Specifically | 4 | ||
| 96 | 36832 | PRA Single Antigen, IgG Glass I and Class II | 3 | ||
| 97 | 86833 | PRA Single Antigen, IgG Glass I and Class II | 5 | ||
| 98 | LAB6605 | Epidermal Nerve fiber Density | 5 | ||
| 99 | 85246 | Von Willebrand Factor Activity | 5 | ||
| 100 | 85290 | Factor 13 Antigen Subunit A | 5 | ||
| 101 | 83520 | Interleukin-5 by Multiplex Bead Assay | 2 | ||
| 102 | 83945 | Oxalate | 2 | ||
| 103 | 835202x2 | Interleukin 3 | 5 | ||
| 104 | LAB6605 | ENF: Skin Biopsy for Nerve density; Confocal microscopy | 5 | ||
| 105 | 85290 | Factor XIII Activity-TC 2006182 | 1 | ||
| 106 | 83051 | Hemoglobin, Plasma | 10 | ||
| 107 | |||||
| 108 | |||||
| 109 | |||||
| 110 | |||||
| 111 | |||||
| 112 | |||||
| 113 | |||||
| 114 | |||||
| Total | $ - 0 | $ - 0 |
https://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13clab.zip https://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13clab.zip Option Period 1
ATTACHMENT 5 - SCHEDULE OF ITEMS - PRICING
| OPTION PERIOD 1 | ||
| DESCRIPTION | Option Period 1 |
Estimated volume Option Period 1
(OFFEROR TO COMPLETE) Option Period 1
| CLIN | REFERENCE CPT CODE(S) | Specialized Laboratory and Consultation Services | |||
| 1 | 84311 | Adenosine Deaminase, Pericardial | 2 | ||
| 2 | 80150 | Amikacin Level | 4 | ||
| 3 | 80335 | Amitriptyline/Nortriptyline | 4 | ||
| 4 | 86334 | Beta-2 Transferrin | 5 | ||
| 5 | 81370 | HLA ABDssop (BMT HLA DR/DQ) Panel | 25 | ||
| 6 | 81376 (x3) | HLA-LowRes Class II 1 Loci | 25 | ||
| 7 | 86162 | Complement CH50, Total | 35 | ||
| 8 | 82595 | Cryoglobulin, Quantitative | 160 | ||
| 9 | 86334 | Cryoglobulin Identification | 51 | ||
| 10 | 80158 | Cyclosporin | 145 | ||
| 11 | 80169 | Everolimus | 15 | ||
| 12 | 83520 | Granulocyte Colony Stimulating Factor | 2 | ||
| 13 | 83520 | Granulocyte Macrophage CS Factor | 2 | ||
| 14 | 86828 | HLA PRA (Screen) | 2 | ||
| 15 | 86832 | HLA PRA (Class 1) | 2 | ||
| 16 | 86833 | HLA PRA (Class 2) | 2 | ||
| 17 | 80299 | Methotrexate | 45 | ||
| 18 | 82657 | Porphobilinogen Deaminase, RBC | 2 | ||
| 19 | 80188 | Primidone | 5 | ||
| 20 | 80192 | Procainamide & N-Acetylprocainamide (NAPA) | 4 | ||
| 21 | 80194 | Quinidine | 2 | ||
| 22 | 80195 | Sirolimus | 40 | ||
| 23 | 80299 | Sulfonylurea Screen | 4 | ||
| 24 | 80197 | Tacrolimus | 700 | ||
| 25 | 80200 | Tobramycin | 15 | ||
| 26 | 82710 | Fat, Feces, Quantitative, Timed Collection | 15 | ||
| 27 | 82705 | Fat, Feces, Quantitative, Ramdom Collection | 10 | ||
| 28 | 85307 | Activated Protein C | 3 | ||
| 29 | 85379 | D-Dimer, Quantitative | 1 | ||
| 30 | 85260 | Factor 10, Chromogenic | 25 | ||
| 31 | 85270 | Factor 11 Activity | 1 | ||
| 32 | 85280 | Factor 12 Activity | 1 | ||
| 33 | 85240 | Factor 8 Activity | 1 | ||
| 34 | 85250 | Factor 9 Activity | 1 | ||
| 35 | 85210 | Factor 2 Activity | 1 | ||
| 36 | 85220 | Factor 5 Activity | 1 | ||
| 37 | 85230 | Factor 7 Activity | 1 | ||
| 38 | 85260 | Factor 10 Activity | 1 | ||
| 39 | 85384 | Fibrinogen Activity | 1 | ||
| 40 | 85520 | Arixtra (Fondaparinux) Assay | 5 | ||
| 41 | 86022 | Heparin Induced Thrombocytopenia | 1 | ||
| 42 | 85520 | Heparin (10a) Level | 1 | ||
| 43 | 85730 (PTT) | Lupus Anticoagulant Panel | 1 | ||
| 44 | 85732 (PTT Mix) | Partial Thromboplastin Time (PTT) Mixing Study | 1 | ||
| 45 | 85597 (PLTNEU) | Platelet Neurtralization | 1 | ||
| 46 | 85613 (DRVVT Screen) | Dilute Russell's viper Venom time (dRVVT) Screen | 1 | ||
| 47 | 85613 (DRVVT Mix) | Dilute Russell's viper Venom time (dRVVT) Mix | 1 | ||
| 48 | 85613 (DRVVT Confirm) | Dilute Russell's viper Venom time (dRVVT) Confirmation | 1 | ||
| 49 | 85525 (Hepzyme if required) | Hepzyme inhibitor to be used as needed to determine heparin contamination | 1 | ||
| 50 | 85420 | Plasminogen Activity | 1 | ||
| 51 | 85576 | Platelet Aggregation Tests | 1 | ||
| 52 | 85576 Col/EPI | Platelet Function Closure Time | 15 | ||
| 53 | 85576 Col/ADP if performed | Reflex: Platelet Function Closure Time ADP | 10 | ||
| 54 | 85730 | Partial Thromboplastin Time (PTT) | 1 | ||
| 55 | 85610 | Protime/INR | 3 | ||
| 56 | 85670 | Thrombin Time | 1 | ||
| 57 | 85576 | Platelet Function P2Y12 (Verify Now) | 1 | ||
| 58 | 85335 (Bethesda assay) | Bethesda Assay for Factor 8 with Normal Plasma | 1 | ||
| 59 | 85335 (Bethesda assay) | Bethesda Assay for Factor 9 with Normal Plasma | 1 | ||
| 60 | 87801 | Bordetella pertussis/parapertussis PCR | 22 | ||
| 61 | 87496 | Cytomegalovirus qual PCR (CSF) | 12 | ||
| 62 | 87496 | Cytomegalovirus qual PCR (Bone Marrow) | 118 | ||
| 63 | 87497 | Cytomegalovirus quantitative PCR | 1 | ||
| 64 | 87498 | Enterovirus PCR (CSF) | 10 | ||
| 65 | 87799 | Epstein-Barr Virus PCR | 12 | ||
| 66 | 87529x2 | Herpes Simplex Culture w/typing test | 6 | ||
| 67 | 87529x2 | Herpes Simplex Virus PCR test (CSF) | 20 | ||
| 68 | Influenza A & B culture and rapid test | 8 | |||
| 69 | 87109 | Mycoplasma Culture test | 3 | ||
| 70 | 87109 | Ureaplasma culture test | 3 | ||
| 71 | 87633 | Respiratory Virus Panel test (PCR, extended) | 8 | ||
| 72 | 87798 | Varicella-Zoster Virus PCR test - non blood | 22 | ||
| 73 | 87252 | Viral Culture-Non-Respiratory | 100 | ||
| 74 | 87253 | Viral Culture-Non-Respiratory Reflex to ID | 100 | ||
| 75 | 87252 | Viral Culture-Respiratory | 100 | ||
| 76 | 87253 | Viral Culture-Respiratory | 100 | ||
| 77 | 87798 | Varicella-Zoster Virus PCR test Qualitative (Blood) | 10 | ||
| 78 | 87254 | Viral Culture, Rapid Resipratory | 180 | ||
| 79 | Fondaparinux | 1 | |||
| 80 | Stat Fondaparinux (Additional $200 for stat) | 1 | |||
| 81 | 87624 | Human Papillomavirus Detection HPVMD | 5 | ||
| 82 | 88342 | TC initial, ImmunohistoChemistry stain | 7 | ||
| 83 | 88343 | TC additional, ImmunohistoChemistry stain | 7 | ||
| 84 | Neuropathological Gross Exam | 4 | |||
| 85 | 88312 | Organism Stain (group 1) | 5 | ||
| 86 | 88312-26 | Organism Stain , interp. | 1 | ||
| 87 | 88313 | Organism Stain (group 2) | 5 | ||
| 88 | 88313-26 | Organism Stain (group 2), interp. | 1 | ||
| 89 | 88323 | Path block consult PC | 1 | ||
| 90 | 88323 | Path Consult & Report w/slide prep | 4 | ||
| 91 | 88321 | Path Consult & Report, Outside Cases (Brains) | 5 | ||
| 92 | 88321 | Revuew Outside Slides Pro Free | 1 | ||
| 93 | 6051014 | Doctor Neuropatholgy Autopsies | 50 | ||
| 94 | 88231 | Specialized Consulti with Dr. Snover specifically - Review outside slides (TC & PF Charges) | 4 | ||
| 95 | 88235 | Path Comprehensive Consult with Dr. Snover Specifically | 4 | ||
| 96 | 36832 | PRA Single Antigen, IgG Glass I and Class II | 3 | ||
| 97 | 86833 | PRA Single Antigen, IgG Glass I and Class II | 5 | ||
| 98 | LAB6605 | Epidermal Nerve fiber Density | 5 | ||
| 99 | 85246 | Von Willebrand Factor Activity | 5 | ||
| 100 | 85290 | Factor 13 Antigen Subunit A | 5 | ||
| 101 | 83520 | Interleukin-5 by Multiplex Bead Assay | 2 | ||
| 102 | 83945 | Oxalate | 2 | ||
| 103 | 835202x2 | Interleukin 3 | 5 | ||
| 104 | LAB6605 | ENF: Skin Biopsy for Nerve density; Confocal microscopy | 5 | ||
| 105 | 85290 | Factor XIII Activity-TC 2006182 | 1 | ||
| 106 | 83051 | Hemoglobin, Plasma | 10 | ||
| 107 | |||||
| 108 | |||||
| 109 | |||||
| 110 | |||||
| 111 | |||||
| 112 | |||||
| 113 | |||||
| 114 | |||||
| Total | $ - 0 | $ - 0 |
https://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13clab.zip
Option Period 2
ATTACHMENT 5 - SCHEDULE OF ITEMS - PRICING
| OPTION PERIOD 2 | ||
| DESCRIPTION | Option Period 2 |
Estimated volume Option Period 2
(OFFEROR TO COMPLETE) Option Period 2
| CLIN | REFERENCE CPT CODE(S) | Specialized Laboratory and Consultation Services | |||
| 1 | 84311 | Adenosine Deaminase, Pericardial | 2 | ||
| 2 | 80150 | Amikacin Level | 4 | ||
| 3 | 80335 | Amitriptyline/Nortriptyline | 4 | ||
| 4 | 86334 | Beta-2 Transferrin | 5 | ||
| 5 | 81370 | HLA ABDssop (BMT HLA DR/DQ) Panel | 25 | ||
| 6 | 81376 (x3) | HLA-LowRes Class II 1 Loci | 25 | ||
| 7 | 86162 | Complement CH50, Total | 35 | ||
| 8 | 82595 | Cryoglobulin, Quantitative | 160 | ||
| 9 | 86334 | Cryoglobulin Identification | 51 | ||
| 10 | 80158 | Cyclosporin | 145 | ||
| 11 | 80169 | Everolimus | 15 | ||
| 12 | 83520 | Granulocyte Colony Stimulating Factor | 2 | ||
| 13 | 83520 | Granulocyte Macrophage CS Factor | 2 | ||
| 14 | 86828 | HLA PRA (Screen) | 2 | ||
| 15 | 86832 | HLA PRA (Class 1) | 2 | ||
| 16 | 86833 | HLA PRA (Class 2) | 2 | ||
| 17 | 80299 | Methotrexate | 45 | ||
| 18 | 82657 | Porphobilinogen Deaminase, RBC | 2 | ||
| 19 | 80188 | Primidone | 5 | ||
| 20 | 80192 | Procainamide & N-Acetylprocainamide (NAPA) | 4 | ||
| 21 | 80194 | Quinidine | 2 | ||
| 22 | 80195 | Sirolimus | 40 | ||
| 23 | 80299 | Sulfonylurea Screen | 4 | ||
| 24 | 80197 | Tacrolimus | 700 | ||
| 25 | 80200 | Tobramycin | 15 | ||
| 26 | 82710 | Fat, Feces, Quantitative, Timed Collection | 15 | ||
| 27 | 82705 | Fat, Feces, Quantitative, Ramdom Collection | 10 | ||
| 28 | 85307 | Activated Protein C | 3 | ||
| 29 | 85379 | D-Dimer, Quantitative | 1 | ||
| 30 | 85260 | Factor 10, Chromogenic | 25 | ||
| 31 | 85270 | Factor 11 Activity | 1 | ||
| 32 | 85280 | Factor 12 Activity | 1 | ||
| 33 | 85240 | Factor 8 Activity | 1 | ||
| 34 | 85250 | Factor 9 Activity | 1 | ||
| 35 | 85210 | Factor 2 Activity | 1 | ||
| 36 | 85220 | Factor 5 Activity | 1 | ||
| 37 | 85230 | Factor 7 Activity | 1 | ||
| 38 | 85260 | Factor 10 Activity | 1 | ||
| 39 | 85384 | Fibrinogen Activity | 1 | ||
| 40 | 85520 | Arixtra (Fondaparinux) Assay | 5 | ||
| 41 | 86022 | Heparin Induced Thrombocytopenia | 1 | ||
| 42 | 85520 | Heparin (10a) Level | 1 | ||
| 43 | 85730 (PTT) | Lupus Anticoagulant Panel | 1 | ||
| 44 | 85732 (PTT Mix) | Partial Thromboplastin Time (PTT) Mixing Study | 1 | ||
| 45 | 85597 (PLTNEU) | Platelet Neutralization | 1 | ||
| 46 | 85613 (DRVVT Screen) | Dilute Russell's viper Venom time (dRVVT) Screen | 1 | ||
| 47 | 85613 (DRVVT Mix) | Dilute Russell's viper Venom time (dRVVT) Mix | 1 | ||
| 48 | 85613 (DRVVT Confirm) | Dilute Russell's viper Venom time (dRVVT) Confirmation | 1 | ||
| 49 | 85525 (Hepzyme if required) | Hepzyme inhibitor to be used as needed to determine heparin contamination | 1 | ||
| 50 | 85420 | Plasminogen Activity | 1 | ||
| 51 | 85576 | Platelet Aggregation Tests | 1 | ||
| 52 | 85576 Col/EPI | Platelet Function Closure Time | 15 | ||
| 53 | 85576 Col/ADP if performed | Reflex: Platelet Function Closure Time ADP | 10 | ||
| 54 | 85730 | Partial Thromboplastin Time (PTT) | 1 | ||
| 55 | 85610 | Protime/INR | 3 | ||
| 56 | 85670 | Thrombin Time | 1 | ||
| 57 | 85576 | Platelet Function P2Y12 (Verify Now) | 1 | ||
| 58 | 85335 (Bethesda assay) | Bethesda Assay for Factor 8 with Normal Plasma | 1 | ||
| 59 | 85335 (Bethesda assay) | Bethesda Assay for Factor 9 with Normal Plasma | 1 | ||
| 60 | 87801 | Bordetella pertussis/parapertussis PCR | 22 | ||
| 61 | 87496 | Cytomegalovirus qual PCR (CSF) | 12 | ||
| 62 | 87496 | Cytomegalovirus qual PCR (Bone Marrow) | 118 | ||
| 63 | 87497 | Cytomegalovirus quantitative PCR | 1 | ||
| 64 | 87498 | Enterovirus PCR (CSF) | 10 | ||
| 65 | 87799 | Epstein-Barr Virus PCR | 12 | ||
| 66 | 87529x2 | Herpes Simplex Culture w/typing test | 6 | ||
| 67 | 87529x2 | Herpes Simplex Virus PCR test (CSF) | 20 | ||
| 68 | Influenza A & B culture and rapid test | 8 | |||
| 69 | 87109 | Mycoplasma Culture test | 3 | ||
| 70 | 87109 | Ureaplasma culture test | 3 | ||
| 71 | 87633 | Respiratory Virus Panel test (PCR, extended) | 8 | ||
| 72 | 87798 | Varicella-Zoster Virus PCR test - non blood | 22 | ||
| 73 | 87252 | Viral Culture-Non-Respiratory | 100 | ||
| 74 | 87253 | Viral Culture-Non-Respiratory Reflex to ID | 100 | ||
| 75 | 87252 | Viral Culture-Respiratory | 100 | ||
| 76 | 87253 | Viral Culture-Respiratory | 100 | ||
| 77 | 87798 | Varicella-Zoster Virus PCR test Qualitative (Blood) | 10 | ||
| 78 | 87254 | Viral Culture, Rapid Resipratory | 180 | ||
| 79 | Fondaparinux | 1 | |||
| 80 | Stat Fondaparinux (Additional $200 for stat) | 1 | |||
| 81 | 87624 | Human Papillomavirus Detection HPVMD | 5 | ||
| 82 | 88342 | TC initial, ImmunohistoChemistry stain | 7 | ||
| 83 | 88343 | TC additional, ImmunohistoChemistry stain | 7 | ||
| 84 | Neuropathological Gross Exam | 4 | |||
| 85 | 88312 | Organism Stain (group 1) | 5 | ||
| 86 | 88312-26 | Organism Stain , interp. | 1 | ||
| 87 | 88313 | Organism Stain (group 2) | 5 | ||
| 88 | 88313-26 | Organism Stain (group 2), interp. | 1 | ||
| 89 | 88323 | Path block consult PC | 1 | ||
| 90 | 88323 | Path Consult & Report w/slide prep | 4 | ||
| 91 | 88321 | Path Consult & Report, Outside Cases (Brains) | 5 | ||
| 92 | 88321 | Revuew Outside Slides Pro Free | 1 | ||
| 93 | 6051014 | Doctor Neuropatholgy Autopsies | 50 | ||
| 94 | 88231 | Specialized Consulti with Dr. Snover specifically - Review outside slides (TC & PF Charges) | 4 | ||
| 95 | 88235 | Path Comprehensive Consult with Dr. Snover Specifically | 4 | ||
| 96 | 36832 | PRA Single Antigen, IgG Glass I and Class II | 3 | ||
| 97 | 86833 | PRA Single Antigen, IgG Glass I and Class II | 5 | ||
| 98 | LAB6605 | Epidermal Nerve fiber Density | 5 | ||
| 99 | 85246 | Von Willebrand Factor Activity | 5 | ||
| 100 | 85290 | Factor 13 Antigen Subunit A | 5 | ||
| 101 | 83520 | Interleukin-5 by Multiplex Bead Assay | 2 | ||
| 102 | 83945 | Oxalate | 2 | ||
| 103 | 835202x2 | Interleukin 3 | 5 | ||
| 104 | LAB6605 | ENF: Skin Biopsy for Nerve density; Confocal microscopy | 5 | ||
| 105 | 85290 | Factor XIII Activity-TC 2006182 | 1 | ||
| 106 | 83051 | Hemoglobin, Plasma | 10 | ||
| 107 | |||||
| 108 | |||||
| 109 | |||||
| 110 | |||||
| 111 | |||||
| 112 | |||||
| 113 | |||||
| 114 | |||||
| Total | $ - 0 | $ - 0 |
https://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13clab.zip
Option Period 3
ATTACHMENT 5 - SCHEDULE OF ITEMS - PRICING
| OPTION PERIOD 3 | ||
| DESCRIPTION | Option Period 3 |
Estimated volume Option Period 3
(OFFEROR TO COMPLETE) Option Period 3
| CLIN | REFERENCE CPT CODE(S) | Specialized Laboratory and Consultation Services | |||
| 1 | 84311 | Adenosine Deaminase, Pericardial | 2 | ||
| 2 | 80150 | Amikacin Level | 4 | ||
| 3 | 80335 | Amitriptyline/Nortriptyline | 4 | ||
| 4 | 86334 | Beta-2 Transferrin | 5 | ||
| 5 | 81370 | HLA ABDssop (BMT HLA DR/DQ) Panel | 25 | ||
| 6 | 81376 (x3) | HLA-LowRes Class II 1 Loci | 25 | ||
| 7 | 86162 | Complement CH50, Total | 35 | ||
| 8 | 82595 | Cryoglobulin, Quantitative | 160 | ||
| 9 | 86334 | Cryoglobulin Identification | 51 | ||
| 10 | 80158 | Cyclosporin | 145 | ||
| 11 | 80169 | Everolimus | 15 | ||
| 12 | 83520 | Granulocyte Colony Stimulating Factor | 2 | ||
| 13 | 83520 | Granulocyte Macrophage CS Factor | 2 | ||
| 14 | 86828 | HLA PRA (Screen) | 2 | ||
| 15 | 86832 | HLA PRA (Class 1) | 2 | ||
| 16 | 86833 | HLA PRA (Class 2) | 2 | ||
| 17 | 80299 | Methotrexate | 45 | ||
| 18 | 82657 | Porphobilinogen Deaminase, RBC | 2 | ||
| 19 | 80188 | Primidone | 5 | ||
| 20 | 80192 | Procainamide & N-Acetylprocainamide (NAPA) | 4 | ||
| 21 | 80194 | Quinidine | 2 | ||
| 22 | 80195 | Sirolimus | 40 | ||
| 23 | 80299 | Sulfonylurea Screen | 4 | ||
| 24 | 80197 | Tacrolimus | 700 | ||
| 25 | 80200 | Tobramycin | 15 | ||
| 26 | 82710 | Fat, Feces, Quantitative, Timed Collection | 15 | ||
| 27 | 82705 | Fat, Feces, Quantitative, Ramdom Collection | 10 | ||
| 28 | 85307 | Activated Protein C | 3 | ||
| 29 | 85379 | D-Dimer, Quantitative | 1 | ||
| 30 | 85260 | Factor 10, Chromogenic | 25 | ||
| 31 | 85270 | Factor 11 Activity | 1 | ||
| 32 | 85280 | Factor 12 Activity | 1 | ||
| 33 | 85240 | Factor 8 Activity | 1 | ||
| 34 | 85250 | Factor 9 Activity | 1 | ||
| 35 | 85210 | Factor 2 Activity | 1 | ||
| 36 | 85220 | Factor 5 Activity | 1 | ||
| 37 | 85230 | Factor 7 Activity | 1 | ||
| 38 | 85260 | Factor 10 Activity | 1 | ||
| 39 | 85384 | Fibrinogen Activity | 1 | ||
| 40 | 85520 | Arixtra (Fondaparinux) Assay | 5 | ||
| 41 | 86022 | Heparin Induced Thrombocytopenia | 1 | ||
| 42 | 85520 | Heparin (10a) Level | 1 | ||
| 43 | 85730 (PTT) | Lupus Anticoagulant Panel | 1 | ||
| 44 | 85732 (PTT Mix) | Partial Thromboplastin Time (PTT) Mixing Study | 1 | ||
| 45 | 85597 (PLTNEU) | Platelet Neutralization | 1 | ||
| 46 | 85613 (DRVVT Screen) | Dilute Russell's viper Venom time (dRVVT) Screen | 1 | ||
| 47 | 85613 (DRVVT Mix) | Dilute Russell's viper Venom time (dRVVT) Mix | 1 | ||
| 48 | 85613 (DRVVT Confirm) | Dilute Russell's viper Venom time (dRVVT) Confirmation | 1 | ||
| 49 | 85525 (Hepzyme if required) | Hepzyme inhibior tot be used as needed to determine heparin contamination | 1 | ||
| 50 | 85420 | Plasminogen Activity | 1 | ||
| 51 | 85576 | Platelet Aggregation Tests | 1 | ||
| 52 | 85576 Col/EPI | Platelet Function Closure Time | 15 | ||
| 53 | 85576 Col/ADP if performed | Reflex: Platelet Function Closure Time ADP | 10 | ||
| 54 | 85730 | Partial Thromboplastin Time (PTT) | 1 | ||
| 55 | 85610 | Protime/INR | 3 | ||
| 56 | 85670 | Thrombin Time | 1 | ||
| 57 | 85576 | Platelet Function P2Y12 (Verify Now) | 1 | ||
| 58 | 85335 (Bethesda assay) | Bethesda Assay for Factor 8 with Normal Plasma | 1 | ||
| 59 | 85335 (Bethesda assay) | Bethesda Assay for Factor 9 with Normal Plasma | 1 | ||
| 60 | 87801 | Bordetella pertussis/parapertussis PCR | 22 | ||
| 61 | 87496 | Cytomegalovirus qual PCR (CSF) | 12 | ||
| 62 | 87496 | Cytomegalovirus qual PCR (Bone Marrow) | 118 | ||
| 63 | 87497 | Cytomegalovirus quantitative PCR | 1 | ||
| 64 | 87498 | Enterovirus PCR (CSF) | 10 | ||
| 65 | 87799 | Epstein-Barr Virus PCR | 12 | ||
| 66 | 87529x2 | Herpes Simplex Culture w/typing test | 6 | ||
| 67 | 87529x2 | Herpes Simplex Virus PCR test (CSF) | 20 | ||
| 68 | Influenza A & B culture and rapid test | 8 | |||
| 69 | 87109 | Mycoplasma Culture test | 3 | ||
| 70 | 87109 | Ureaplasma culture test | 3 | ||
| 71 | 87633 | Respiratory Virus Panel test (PCR, extended) | 8 | ||
| 72 | 87798 | Varicella-Zoster Virus PCR test - non blood | 22 | ||
| 73 | 87252 | Viral Culture-Non-Respiratory | 100 | ||
| 74 | 87253 | Viral Culture-Non-Respiratory Reflex to ID | 100 | ||
| 75 | 87252 | Viral Culture-Respiratory | 100 | ||
| 76 | 87253 | Viral Culture-Respiratory | 100 | ||
| 77 | 87798 | Varicella-Zoster Virus PCR test Qualitative (Blood) | 10 | ||
| 78 | 87254 | Viral Culture, Rapid Resipratory | 180 | ||
| 79 | Fondaparinux | 1 | |||
| 80 | Stat Fondaparinux (Additional $200 for stat) | 1 | |||
| 81 | 87624 | Human Papillomavirus Detection HPVMD | 5 | ||
| 82 | 88342 | TC initial, ImmunohistoChemistry stain | 7 | ||
| 83 | 88343 | TC additional, ImmunohistoChemistry stain | 7 | ||
| 84 | Neuropathological Gross Exam | 4 | |||
| 85 | 88312 | Organism Stain (group 1) | 5 | ||
| 86 | 88312-26 | Organism Stain , interp. | 1 | ||
| 87 | 88313 | Organism Stain (group 2) | 5 | ||
| 88 | 88313-26 | Organism Stain (group 2), interp. | 1 | ||
| 89 | 88323 | Path block consult PC | 1 | ||
| 90 | 88323 | Path Consult & Report w/slide prep | 4 | ||
| 91 | 88321 | Path Consult & Report, Outside Cases (Brains) | 5 | ||
| 92 | 88321 | Revuew Outside Slides Pro Free | 1 | ||
| 93 | 6051014 | Doctor Neuropatholgy Autopsies | 50 | ||
| 94 | 88231 | Specialized Consulti with Dr. Snover specifically - Review outside slides (TC & PF Charges) | 4 | ||
| 95 | 88235 | Path Comprehensive Consult with Dr. Snover Specifically | 4 | ||
| 96 | 36832 | PRA Single Antigen, IgG Glass I and Class II | 3 | ||
| 97 | 86833 | PRA Single Antigen, IgG Glass I and Class II | 5 | ||
| 98 | LAB6605 | Epidermal Nerve fiber Density | 5 | ||
| 99 | 85246 | Von Willebrand Factor Activity | 5 | ||
| 100 | 85290 | Factor 13 Antigen Subunit A | 5 | ||
| 101 | 83520 | Interleukin-5 by Multiplex Bead Assay | 2 | ||
| 102 | 83945 | Oxalate | 2 | ||
| 103 | 835202x2 | Interleukin 3 | 5 | ||
| 104 | LAB6605 | ENF: Skin Biopsy for Nerve density; Confocal microscopy | 5 | ||
| 105 | 85290 | Factor XIII Activity-TC 2006182 | 1 | ||
| 106 | 83051 | Hemoglobin, Plasma | 10 | ||
| 107 | |||||
| 108 | |||||
| 109 | |||||
| 110 | |||||
| 111 | |||||
| 112 | |||||
| 113 | |||||
| 114 | |||||
| Total | $ - 0 | $ - 0 |
https://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13clab.zip
Option Period 4
ATTACHMENT 5 - SCHEDULE OF ITEMS - PRICING
| OPTION PERIOD 4 | ||
| DESCRIPTION | Option Period |
Estimated volume Option Period 4
(OFFEROR TO COMPLETE) Option Period 4
| CLIN | REFERENCE CPT CODE(S) | Specialized Laboratory and Consultation Services | |||
| 1 | 84311 | Adenosine Deaminase, Pericardial | 2 | ||
| 2 | 80150 | Amikacin Level | 4 | ||
| 3 | 80335 | Amitriptyline/Nortriptyline | 4 | ||
| 4 | 86334 | Beta-2 Transferrin | 5 | ||
| 5 | 81370 | HLA ABDssop (BMT HLA DR/DQ) Panel | 25 | ||
| 6 | 81376 (x3) | HLA-LowRes Class II 1 Loci | 25 | ||
| 7 | 86162 | Complement CH50, Total | 35 | ||
| 8 | 82595 | Cryoglobulin, Quantitative | 160 | ||
| 9 | 86334 | Cryoglobulin Identification | 51 | ||
| 10 | 80158 | Cyclosporin | 145 | ||
| 11 | 80169 | Everolimus | 15 | ||
| 12 | 83520 | Granulocyte Colony Stimulating Factor | 2 | ||
| 13 | 83520 | Granulocyte Macrophage CS Factor | 2 | ||
| 14 | 86828 | HLA PRA (Screen) | 2 | ||
| 15 | 86832 | HLA PRA (Class 1) | 2 | ||
| 16 | 86833 | HLA PRA (Class 2) | 2 | ||
| 17 | 80299 | Methotrexate | 45 | ||
| 18 | 82657 | Porphobilinogen Deaminase, RBC | 2 | ||
| 19 | 80188 | Primidone | 5 | ||
| 20 | 80192 | Procainamide & N-Acetylprocainamide (NAPA) | 4 | ||
| 21 | 80194 | Quinidine | 2 | ||
| 22 | 80195 | Sirolimus | 40 | ||
| 23 | 80299 | Sulfonylurea Screen | 4 | ||
| 24 | 80197 | Tacrolimus | 700 | ||
| 25 | 80200 | Tobramycin | 15 | ||
| 26 | 82710 | Fat, Feces, Quantitative, Timed Collection | 15 | ||
| 27 | 82705 | Fat, Feces, Quantitative, Ramdom Collection | 10 | ||
| 28 | 85307 | Activated Protein C | 3 | ||
| 29 | 85379 | D-Dimer, Quantitative | 1 | ||
| 30 | 85260 | Factor 10, Chromogenic | 25 | ||
| 31 | 85270 | Factor 11 Activity | 1 | ||
| 32 | 85280 | Factor 12 Activity | 1 | ||
| 33 | 85240 | Factor 8 Activity | 1 | ||
| 34 | 85250 | Factor 9 Activity | 1 | ||
| 35 | 85210 | Factor 2 Activity | 1 | ||
| 36 | 85220 | Factor 5 Activity | 1 | ||
| 37 | 85230 | Factor 7 Activity | 1 | ||
| 38 | 85260 | Factor 10 Activity | 1 | ||
| 39 | 85384 | Fibrinogen Activity | 1 | ||
| 40 | 85520 | Arixtra (Fondaparinux) Assay | 5 | ||
| 41 | 86022 | Heparin Induced Thrombocytopenia | 1 | ||
| 42 | 85520 | Heparin (10a) Level | 1 | ||
| 43 | 85730 (PTT) | Lupus Anticoagulant Panel | 1 | ||
| 44 | 85732 (PTT Mix) | Partial Thromboplastin Time (PTT) Mixing Study | 1 | ||
| 45 | 85597 (PLTNEU) | Platelet Neutralization | 1 | ||
| 46 | 85613 (DRVVT Screen) | Dilute Russell's viper Venom time (dRVVT) Screen | 1 | ||
| 47 | 85613 (DRVVT Mix) | Dilute Russell's viper Venom time (dRVVT) Mix | 1 | ||
| 48 | 85613 (DRVVT Confirm) | Dilute Russell's viper Venom time (dRVVT) Confirmation | 1 | ||
| 49 | 85525 (Hepzyme if required) | Hepzyme inhibitor to be used as needed to determine heparin contamination | 1 | ||
| 50 | 85420 | Plasminogen Activity | 1 | ||
| 51 | 85576 | Platelet Aggregation Tests | 1 | ||
| 52 | 85576 Col/EPI | Platelet Function Closure Time | 15 | ||
| 53 | 85576 Col/ADP if performed | Reflex: Platelet Function Closure Time ADP | 10 | ||
| 54 | 85730 | Partial Thromboplastin Time (PTT) | 1 | ||
| 55 | 85610 | Protime/INR | 3 | ||
| 56 | 85670 | Thrombin Time | 1 | ||
| 57 | 85576 | Platelet Function P2Y12 (Verify Now) | 1 | ||
| 58 | 85335 (Bethesda assay) | Bethesda Assay for Factor 8 with Normal Plasma | 1 | ||
| 59 | 85335 (Bethesda assay) | Bethesda Assay for Factor 9 with Normal Plasma | 1 | ||
| 60 | 87801 | Bordetella pertussis/parapertussis PCR | 22 | ||
| 61 | 87496 | Cytomegalovirus qual PCR (CSF) | 12 | ||
| 62 | 87496 | Cytomegalovirus qual PCR (Bone Marrow) | 118 | ||
| 63 | 87497 | Cytomegalovirus quantitative PCR | 1 | ||
| 64 | 87498 | Enterovirus PCR (CSF) | 10 | ||
| 65 | 87799 | Epstein-Barr Virus PCR | 12 | ||
| 66 | 87529x2 | Herpes Simplex Culture w/typing test | 6 | ||
| 67 | 87529x2 | Herpes Simplex Virus PCR test (CSF) | 20 | ||
| 68 | Influenza A & B culture and rapid test | 8 | |||
| 69 | 87109 | Mycoplasma Culture test | 3 | ||
| 70 | 87109 | Ureaplasma culture test | 3 | ||
| 71 | 87633 | Respiratory Virus Panel test (PCR, extended) | 8 | ||
| 72 | 87798 | Varicella-Zoster Virus PCR test - non blood | 22 | ||
| 73 | 87252 | Viral Culture-Non-Respiratory | 100 | ||
| 74 | 87253 | Viral Culture-Non-Respiratory Reflex to ID | 100 | ||
| 75 | 87252 | Viral Culture-Respiratory | 100 | ||
| 76 | 87253 | Viral Culture-Respiratory | 100 | ||
| 77 | 87798 | Varicella-Zoster Virus PCR test Qualitative (Blood) | 10 | ||
| 78 | 87254 | Viral Culture, Rapid Resipratory | 180 | ||
| 79 | Fondaparinux | 1 | |||
| 80 | Stat Fondaparinux (Additional $200 for stat) | 1 | |||
| 81 | 87624 | Human Papillomavirus Detection HPVMD | 5 | ||
| 82 | 88342 | TC initial, ImmunohistoChemistry stain | 7 | ||
| 83 | 88343 | TC additional, ImmunohistoChemistry stain | 7 | ||
| 84 | Neuropathological Gross Exam | 4 | |||
| 85 | 88312 | Organism Stain (group 1) | 5 | ||
| 86 | 88312-26 | Organism Stain , interp. | 1 | ||
| 87 | 88313 | Organism Stain (group 2) | 5 | ||
| 88 | 88313-26 | Organism Stain (group 2), interp. | 1 | ||
| 89 | 88323 | Path block consult PC | 1 | ||
| 90 | 88323 | Path Consult & Report w/slide prep | 4 | ||
| 91 | 88321 | Path Consult & Report, Outside Cases (Brains) | 5 | ||
| 92 | 88321 | Revuew Outside Slides Pro Free | 1 | ||
| 93 | 6051014 | Doctor Neuropatholgy Autopsies | 50 | ||
| 94 | 88231 | Specialized Consulti with Dr. Snover specifically - Review outside slides (TC & PF Charges) | 4 | ||
| 95 | 88235 | Path Comprehensive Consult with Dr. Snover Specifically | 4 | ||
| 96 | 36832 | PRA Single Antigen, IgG Glass I and Class II | 3 | ||
| 97 | 86833 | PRA Single Antigen, IgG Glass I and Class II | 5 | ||
| 98 | LAB6605 | Epidermal Nerve fiber Density | 5 | ||
| 99 | 85246 | Von Willebrand Factor Activity | 5 | ||
| 100 | 85290 | Factor 13 Antigen Subunit A | 5 | ||
| 101 | 83520 | Interleukin-5 by Multiplex Bead Assay | 2 | ||
| 102 | 83945 | Oxalate | 2 | ||
| 103 | 835202x2 | Interleukin 3 | 5 | ||
| 104 | LAB6605 | ENF: Skin Biopsy for Nerve density; Confocal microscopy | 5 | ||
| 105 | 85290 | Factor XIII Activity-TC 2006182 | 1 | ||
| 106 | 83051 | Hemoglobin, Plasma | 10 | ||
| 107 | |||||
| 108 | |||||
| 109 | |||||
| 110 | |||||
| 111 | |||||
| 112 | |||||
| 113 | |||||
| 114 | |||||
| Total | $ - 0 | $ - 0 |
https://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13clab.zip
File details come from the government source that posted it.