36C26324Q0292 Pathology Physician Labs.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER

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. UEI: EFT:

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. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C26324Q0292

6. SOLICITATION ISSUE DATE

8-07-2025

Nicole Burski 320-252-1670 x5699 08-19-2025

10:00 AM CDT

36C263 Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

Contract Officer 4801 Veterans Drive St. Cloud MN 56303 Nicole Burski nicole.burski@va.gov

X 100

X

Y

621511

$41.5 Million

N/A

X

Department of Veterans Affairs Central Iowa VA Health Care System 3600 30th Street

Des Moines IA 50310-5753

Department of Veterans Affaires

NETWORK 23 CONTRACTING OFFICE

Contract Specialist 4801 Veterans Drive St. Cloud MN 56303

Department of Veterans Affairs Financial Service Center PO Box 149971

Austin TX 78714

512-460-5540

See CONTINUATION Page

Pathology and Laboratory Medicine Services to support the the VA Central Health Care System located in Des Moines, IA.

See Section B.2 Schedule of Services.

See Section B.3 Performance Work Statement.

Offerors must be active in the System for Award Management (SAM.gov) upon submission of a quote until award.

See CONTINUATION Page

X one(1)

Nicole Burski

VA-VHA-RPOC-2024-0074

36C26324Q0292

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF SERVICES

B.3 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (NOV 2023)

C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.3 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR

PERSONNEL (JAN 2011)

C.4 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (NOV 2021)

C.5 52.216-18 ORDERING (AUG 2020)

C.6 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.7 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.8 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.9 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) . 114

C.10 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.11 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR

1984)

C.12 VAAR 852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 2022)

C.13 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.14 VAAR 852.204-70 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR

PERSONNEL (MAY 2020)

C.15 VAAR 852.204-71 INFORMATION AND INFORMATION SYSTEMS SECURITY

(FEB 2023)

C.16 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT FOR DATA

BREACH COSTS (FEB 2023) ALTERNATE I (FEB 2023)

C.17 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS

(NOV 2018)

C.18 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.19 VAAR 852.237-74 NON-DISCRIMINATION IN SERVICE DELIVERY (OCT 2019)

C.20 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.21 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) 128

C.22 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (JAN 2025) (DEVIATION FEB 2025)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 ATTACHMENT - IMMIGRATION CERTIFICATION

D.2 ATTACHMENT - ORGANIZATIONAL CONFLICT OF INTEREST

D.3 ATTACHMENT - RULES OF BEHAVIOR

D.4 ATTACHMENT - QUALITY ASSURANCE SURVEILLANCE PLAN – QASP

D.5 ATTACHMENT - SUBCONTRACTING LIMITATION ACKNOWLEDGEMENT

D.6 ATTACHMENT - WAGE DETERMINATION 2015-4979 REV 22

D.7 ATTACHMENT - 42 CFR 415.170

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023)

E.2 52.201-1 ACQUISITION 360: VOLUNTARY SURVEY (SEP 2023)

E.3 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.4 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.5 52.204-29 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT

ORDERS—REPRESENTATION AND DISCLOSURES (DEC 2023)

E.6 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.7 52.216-1 TYPE OF CONTRACT (APR 1984)

E.8 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.9 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)

E.10 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE

RESOLUTION (OCT 2018)

E.11 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.12 VAAR 852.239-75 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY NOTICE (FEB 2023)

E.13 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (NOV 2021)

E.14 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.15 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (MAY 2024) (DEVIATION

FEB 2025)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. ADMINISTRATION DATA: Contract administration matters will be handled by:

a. CONTRACTOR: Company Name and Address:

SAM Unique Entity ID Number:

Contact Person(s) Name:

Contact Person(s) Email:

Contact Person(s) Telephone:

b. GOVERNMENT: Department of Veterans Affairs Network Contract Office 23 (NCO 23) 4801 Veterans Drive St. Cloud, MN 56303 Contracting Officer: Nicole Burski, 320-255-1670x5699, Nicole.Burski@va.gov Contracting Officer Representative:

Jessica Chapman, 515-699-5676, Jessica.Chapman@va.gov

*If Government contacts change, notification will be sent to the Contractor by e-mail. Contract modification(s) shall not be required.

2. TYPE and TERM OF CONTRACT: The Government intends to establish a single Indefinite Delivery Indefinite Quantity (IDIQ) Contract, consisting of a base year with four (4) additional one-year option periods, which may be exercised at the Government’s discretion.

Task orders will be issued via email at contract award and at the beginning of each option period. Only authorized personnel from Network Contracting Office 23 (NCO23) will have the authority to place orders under this contract. Furthermore, there is an option to extend services for up to six (6) months beyond the four option years.

3. CONTRACT REMITTANCE ADDRESS: All payments by the Government to the Contractor will be made in accordance with FAR 52.232-33, Payment by Electronic Funds Transfer – System for Award Management, and VAAR 852.232-72, Electronic Submission of Payment Requests.

4. INVOICES: Invoices shall be submitted electronically monthly in arrears. The Contracting Officer’s Representative (COR) will review all invoices submitted. The COR is responsible for certifying invoices for payment for only those services received and deemed acceptable by VA. Once certified by the COR, payment can be made via the Tungsten Network.

5. GOVERNMENT INVOICE ADDRESS: All invoices shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

Invoicing shall be in accordance with the requirements of The Department of Veterans Affairs (VA) Financial Services Center (VAFSC). The latest information shall be used for invoicing and payments and may change during the Period of Performance of this acquisition. Current Invoicing information is located at http://www.fsc.va.gov/einvoice.asp.

6. POST-AWARD ORIENTATION: The Contracting Officer will determine the need and, if required, schedule a post award orientation for this acquisition after award in accordance with FAR 42.502.

7. MANDATORY WRITTEN DISCLOSURES: Mandatory written disclosures required by FAR clause 52.203-13 to the Department of Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at https://www.vaoig.gov/hotline/federal-acquisition-regulation-far-52203-13-reporting-instructions and clicking on "FAR clause 52.203-13 Reporting." If you experience difficulty accessing the website, call the Hotline at 1-800-488-8244 for further instructions.

8. ACKNOWLEDGEMENT OF AMENDMENTS: The offeror acknowledges receipt of Amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO. DATE

http://www.fsc.va.gov/einvoice.asp

B.2 SCHEDULE OF SERVICES

The Contractor shall furnish all personnel to provide services necessary to perform comprehensive pathology services to eligible beneficiaries of the Department of Veterans Affairs Central Iowa Health Care System (hereinafter referred to as VACIHCS).

1. Pathologist to perform on-site Monday-Friday microscopic and diagnostic examination of surgical samples with entry of results of all cases including cytology, bone marrows and other off-site consultation and technical work, into the VA electronic medical record (Dragon Medical One).

2. Pathology Assistant (or Pathologist) to perform on-site Monday-Friday dictated gross examination of all surgical specimens submitted via Dragon Medical One.

3. On or off-site provision of peripheral smear examination by a pathologist, second review of all newly diagnosed malignancies, second review of 10% of all cases performed (random, quality review).

4. Administrative monthly meetings.

5. 24/7 on-call coverage for any hours a pathologist is not on site. For emergent cases, such as unscheduled frozen sections, response time will be no greater than 30 minutes.

6. Monday-Friday daily courier services to transport samples to reference lab or contractor’s place of business.

7. Provision of off-site cytology and surgical pathology technical services and stains outside the scope of VACIHCS as outlined on the Per-Procedure Services list.

Includes all professional interpretation of off-site studies such as cytology cases, bone marrow cases, flow cytometry, cytogenetic, FISH/MDS and any special stains or immunohistochemistry tests utilized to support the diagnosis.

Place of Performance:

1. On-site surgical pathology professional services shall be provided at VACIHCS, Pathology & Laboratory Medicine Service, 3600 30th Street Des Moines, IA 50310.

2. Off-site cytology professional and technical work as well as off-site professional consultation on surgical pathology cases and related surgical pathology specialized testing and stains will be completed at the contractor’s place of business or subcontracted laboratory.

Pricing Instructions:

The offeror is instructed to edit the number of sub-line-item number (SLIN) to correspond with the number of key personnel submitted for the line-item number (LIN). Affiliate Offerors shall include the “title” of the personnel submitted. Other commercial health care Offerors shall identify by title/position or level of experience the key personnel submitted. Also, renumber SLINs if adding or removing Key Personnel.

The Contractor shall propose up to 6 general pathologists and 2 pathology assistants to rotate daily on-site coverage. Key on-site personnel must be credentialed and available for scheduling to meet the requirements of the contract. In addition, contractor’s pathology group must include at least one Cytopathologist, one Dermatopathologist and one Hematopathologist to provide off-site consultation (only personnel that will provide on-site services must be credentialed by VACIHCS) to meet the requirements of the contract.

The estimated pricing schedule shall be filled out by the contractor. Be sure to fill out per-test and hourly estimated pricing.

* When pricing round to the nearest whole dollar.

** This solicitation is intended to be awarded as an indefinite delivery indefinite quantity (IDIQ) contract. The schedule consists only of estimates, not commitments to purchase that

ESTIMATED QUANTITY.

*** Period of performance is based on the successful credentialing of candidates. If credentialing is not complete by the time of the period of performance start date the new period of performance will begin upon successful completion of credentialing.

In accordance with FAR 52.216-22, the guaranteed minimum and maximum dollar amounts are listed below. These amounts cover the entire ordering period of the contract. The maximum dollar amount listed shall not be exceeded. The minimum guaranteed amount will be awarded at the time of the contract award via the initial task order for services. Only warranted Contracting Officers from the Department of Veterans Affairs Network Contracting Office 23 may issue task order(s) against the IDIQ contract. Task orders will be issued at the start of each option period.

Minimum $1,000.00

Maximum $7,500,000.00

BASE Year: 10/01/2025 to 09/30/2026

(Off-site per procedure CPT and outside consultation)

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

COST

HR

Pathology Services to support the VA Central Iowa Health Care System (VACIHCS), Des Moines, IA Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories PRODUCT/SERVICE CODE: Q515 - Medical – Pathology

0001AA

260.00 HR $ hr. $_________________

Pathology Assistant

NAME:____________

TITLE:____________

Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories PRODUCT/SERVICE CODE: Q515 - Medical – Pathology

VHASTCBurskN Cross-Out

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

0001AB

624.00 HR $ hr. $_________________

Board Certified/Board Eligible Pathologist On-Site

NAME:____________

TITLE:____________

Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0001AC

382.00 HR $ hr. $_________________

Pathologist Off-Site Consultation

NAME:____________

TITLE:____________

Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0001AD

24.00 HR $ hr. $_________________

Pathology Administrative Meetings Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0001AE

60.00 HR $ hr. $_________________

Pathologist Call-Back

NAME:____________

TITLE:____________

Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0001AF

8,076.00 HR $ hr. $_________________

On-Call Pathology

NAME:____________

TITLE:____________

Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

EA

TESTING PROCEDURES

Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AA

2.00 EA $ ea. $_________________

Braf Gene

CPT Code: 81210 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AB

1.00 EA $ ea. $_________________

CALR Gene Com Variants

CPT Code: 81219 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AC

EGFR Gene Com Variants

CPT Code: 81235 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AD

JAK2 Gene

CPT Code: 81270 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AE

PML/ RARalpha

CPT Code: 81315 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

0002AF

T Cell Receptor Rearrangement CPT Code: 81342 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0002AG

Unlisted Molecular Pathology Procedure CPT Code: 81479 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0002AH

57.00 EA $ ea. $_________________

Bone Marrow Interpretation CPT Code: 85097 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0002AJ

94.00 EA $ ea. $_________________

Cyto Non-Gyn Liquid Prep CPT Code: 88112-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0002AK

98.00 EA $ ea. $_________________

Cytp Dx Eval FNA 1st ea Site CPT Code: 88172-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0002AL

148.00 EA $ ea. $_________________

Fine Needle Aspirate CPT Code: 88173-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

0002AM

103.00 EA $ ea. $_________________

Cytp FNA Eval ea Additional

CPT Code: 88177 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AN

48.00 EA $ ea. $_________________

Flow Cytometry First Antibody

CPT Code: 88184-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

PRODUCT/SERVICE CODE: Q515 - Medical - Pathology

0002AP

276.00 EA $ ea. $_________________

Flow Cytometry Additional Antibodies After Mod

CPT Code: 88185-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AQ

41.00 EA $ ea. $_________________

Tissue Culture for Neoplastic Disorders; Bone Marrow

CPT Code: 88237-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AR

Solid Tumor

CPT Code: 88239-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AS

Chromosome Analysis Count 5 Cells, 1 Karyotype with

Banding CPT Code: 88261-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

0002AT

Chromosome Analysis Count 15-20 Cells, 2 Karyotype with Banding CPT Code: 88262-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AU

Chromosome Analysis Count 45 Cells for Mosaicism, 2

Karyotype with Banding CPT Code: 88263-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AV

30.00 EA $ ea. $_________________

Chromosome Analysis Count 20-25 Cells

CPT Code: 88264-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AW

Cytogenetics DNA Probe

CPT Code: 88271 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AX

Tzank Prep

CPT Code: 88273-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002AY

Cytogenetics 100-300

CPT Code: 88275 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

0002AZ

Chromosome Karyotype Study CPT Code: 88280 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0002BA

Chromosome Analysis Additional Cells Counted, each Study CPT Code: 88285-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0002BB

Cyto/ Molecular Report CPT Code: 88291 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0002BC

584.00 EA $ ea. $_________________

Level IV Surgical Pathology Gross & Microscopic (Bone Marrow) CPT Code: 88305-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0002BD

60.00 EA $ ea. $_________________

Decalcification CPT Code: 88311-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621511 - Medical Laboratories

0002BE

166.00 EA $ ea. $_________________

Special Stain Group 1 CPT Code: 88312-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

0002BF

108.00 EA $ ea. $_________________

Special Stain Group 2

CPT Code: 88313-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BG

Enzyme Histochemistry

CPT Code: 88319-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BH

6.00 EA $ ea. $_________________

Consultation (Slides Prepared Elsewhere)

CPT Code: 88321 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BJ

5.00 EA $ ea. $_________________

Consultation (Requires Preparation of Slides)

CPT Code: 88323 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BK

Consultation, Comprehensive (Requires Review of

Records and Specimens) CPT Code: 88325 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BL

96.00 EA $ ea. $_________________

Immunohistochemistry, per Specimen, each Additional

Single Antibody Stain CPT Code: 88341 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

0002BM

1,005.00 EA $ ea. $_________________ Immuno-Histochemistry

CPT Code: 88342 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BN

62.00 EA $ ea. $_________________

Immunohistochemistry, per Specimen, each Multiplex

Stain CPT Code: 88344 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BP

16.00 EA $ ea. $_________________

Immunofluorescent Study (Each Antibody)

CPT Code: 88346-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BQ

4.00 EA $ ea. $_________________

Electron Microscopy

CPT Code: 88348-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BR

Immunofluorescence Additional Stains

CPT Code: 88350 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BS

51.00 EA $ ea. $_________________

Tumor Immunohistochem/Manual

CPT Code: 88360 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

0002BT

Immunohistochemistry with Computer Assisted Tech

CPT Code: 88361-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BU

17.00 EA $ ea. $_________________

In Situ Hybridization, per Specimen, each Additional Probe

Stain CPT Code: 88364 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BV

24.00 EA $ ea. $_________________

In Situ Hybridization

CPT Code: 88365-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BW

In Situ Hybridization, per Specimen, each Multiplex Probe

Stain CPT Code: 88366 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BX

MDS In Situ TC

CPT Code: 88367-TC Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

0002BY

Morphometric Analysis In Situ Hybridization, Manual, per

Specimen CPT Code: 88368 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002BZ

Specimen, each Additional Single Probe Stain CPT Code: 88369 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CA

Morphometric Analysis, In situ Hybridization each

Additional CPT Code: 88373 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CB

45.00 EA $ ea. $_________________

Morphometric Analysis, In Situ Hybridization

CPT Code: 88374 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CC

8.00 EA $ ea. $_________________

Specimen, each Multiplex Stain CPT Code: 88377 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

0002CD

Surgical Pathology, Gross and Micro, Prostate Needle

Biopsy, Any Method CPT Code: G0416 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CE

First Immune Stain

CPT Code: G0461 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CF

Subsequent Immune Stains

CPT Code: G0462 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CG

MPL Mutation Analysis

CPT Code: 81339 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CH

TP53 Mutation Analysis

CPT Code: 81352 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CJ

SF3BI Mutation Analysis

CPT Code: 81347 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

0002CK

MYD88 Mutation Analysis

CPT Code: 81305 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CL

BCR-ABLI Standard p210, p190

CPT Codes: 81206, 81207 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CM

AML Prognostic Profile After Modification

CPT Code: 81450 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CN

Targeted Genomic Sequence Analysis (NGS

Comprehensive Sarcoma Fusion Profile) CPT Code: 81445 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CP

FGFR CDx Molecular Analysis

CPT Code: 0154U Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

0002CQ

ThyraMIR by Interpace Diagnostics

CPT Code: 0018U Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

0002CR

JAK2 Exon 12-14 Mutation Analysis

CPT Code: 81279 Contract Period: Base Year POP Begin: 10-01-2025 POP End: 09-30-2026

Option Year 1- 10/1/2026 to 09/30/2027 (Off-site per procedure CPT and outside consultation)

Pathology Services to support the VACIHCS, Des Moines, IA

Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1001AA

NAME:____________

TITLE:____________

Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1001AB

1001AC

Pathologist Off-Site Consultation

NAME:____________

TITLE:____________

Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1001AD

Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

1001AE

Pathologist Call-Back

NAME:____________

TITLE:____________

Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1001AF

On-Call Pathology

NAME:____________

TITLE:____________

Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AA

CPT Code: 81210 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AB

CPT Code: 81219 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

1002AC

CPT Code: 81235 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AD

CPT Code: 81270 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AE

CPT Code: 81315 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AF

CPT Code: 81342 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AG

CPT Code: 81479 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AH

CPT Code: 85097 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

1002AJ

CPT Code: 88112-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AK

CPT Code: 88172-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AL

CPT Code: 88173-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AM

CPT Code: 88177 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AN

CPT Code: 88184-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AP

CPT Code: 88185-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

1002AQ

CPT Code: 88237-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AR

CPT Code: 88239-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AS

Banding CPT Code: 88261-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AT

with Banding CPT Code: 88262-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AU

Karyotype with Banding CPT Code: 88263-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

1002AV

CPT Code: 88264-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AW

CPT Code: 88271 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AX

CPT Code: 88273-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AY

CPT Code: 88275 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002AZ

CPT Code: 88280 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BA

Study CPT Code: 88285-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

1002BB

CPT Code: 88291 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BC

Marrow) CPT Code: 88305-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BD

CPT Code: 88311-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BE

CPT Code: 88312-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BF

CPT Code: 88313-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BG

CPT Code: 88319-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

1002BH

CPT Code: 88321 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BJ

CPT Code: 88323 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BK

Records and Specimens) CPT Code: 88325 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BL

Single Antibody Stain CPT Code: 88341 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BM

CPT Code: 88342 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BN

Stain CPT Code: 88344 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

1002BP

CPT Code: 88346-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BQ

CPT Code: 88348-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BR

CPT Code: 88350 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BS

CPT Code: 88360 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BT

CPT Code: 88361-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BU

Stain CPT Code: 88364 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

1002BV

CPT Code: 88365-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BW

Stain CPT Code: 88366 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BX

CPT Code: 88367-TC Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BY

Specimen CPT Code: 88368 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002BZ

Specimen, each Additional Single Probe Stain CPT Code: 88369 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

1002CA

Additional CPT Code: 88373 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CB

CPT Code: 88374 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CC

Specimen, each Multiplex Stain CPT Code: 88377 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CD

Biopsy, Any Method CPT Code: G0416 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CE

CPT Code: G0461 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CF

CPT Code: G0462 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

1002CG

CPT Code: 81339 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CH

CPT Code: 81352 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CJ

CPT Code: 81347 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CK

CPT Code: 81305 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CL

CPT Codes: 81206, 81207 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CM

CPT Code: 81450 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

1002CN

Comprehensive Sarcoma Fusion Profile) CPT Code: 81445 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CP

CPT Code: 0154U Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CQ

CPT Code: 0018U Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

1002CR

CPT Code: 81279 Contract Period: Option Year 1 POP Begin: 10-01-2026 POP End: 09-30-2027

Option Year 2 - 10/1/2027 to 09/30/2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

ANNUAL COST

Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2001AA

NAME:____________

TITLE:____________

Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2001AB

Pathologist On-Site

NAME:____________

TITLE:____________

Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2001AC

Pathologist Off-Site Consultation

NAME:____________

TITLE:____________

Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2001AD

Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2001AE

Pathologist Call-Back

NAME:____________

TITLE:____________

Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2001AF

On-Call Pathology

NAME:____________

TITLE:____________

Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AA

CPT Code: 81210 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AB

CPT Code: 81219 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AC

CPT Code: 81235 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AD

CPT Code: 81270 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2002AE

CPT Code: 81315 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AF

CPT Code: 81342 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AG

CPT Code: 81479 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AH

CPT Code: 85097 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AJ

CPT Code: 88112-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AK

CPT Code: 88172-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2002AL

CPT Code: 88173-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AM

CPT Code: 88177 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AN

CPT Code: 88184-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AP

CPT Code: 88185-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AQ

CPT Code: 88237-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AR

CPT Code: 88239-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2002AS

Banding CPT Code: 88261-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AT

with Banding CPT Code: 88262-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AU

Karyotype with Banding CPT Code: 88263-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AV

CPT Code: 88264-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AW

CPT Code: 88271 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AX

CPT Code: 88273-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2002AY

CPT Code: 88275 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002AZ

CPT Code: 88280 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BA

Study CPT Code: 88285-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BB

CPT Code: 88291 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BC

Marrow) CPT Code: 88305-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BD

CPT Code: 88311-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2002BE

CPT Code: 88312-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BF

CPT Code: 88313-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BG

CPT Code: 88319-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BH

CPT Code: 88321 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BJ

CPT Code: 88323 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BK

Records and Specimens) CPT Code: 88325 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2002BL

Single Antibody Stain CPT Code: 88341 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BM

CPT Code: 88342 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BN

Stain CPT Code: 88344 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BP

CPT Code: 88346-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BQ

CPT Code: 88348-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BR

CPT Code: 88350 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2002BS

CPT Code: 88360 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BT

CPT Code: 88361-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BU

Stain CPT Code: 88364 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BV

CPT Code: 88365-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BW

Stain CPT Code: 88366 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BX

CPT Code: 88367-TC Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2002BY

Specimen CPT Code: 88368 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002BZ

Specimen, each Additional Single Probe Stain CPT Code: 88369 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CA

Additional CPT Code: 88373 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CB

CPT Code: 88374 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CC

Specimen, each Multiplex Stain CPT Code: 88377 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2002CD

Biopsy, Any Method CPT Code: G0416 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CE

CPT Code: G0461 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CF

CPT Code: G0462 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CG

CPT Code: 81339 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CH

CPT Code: 81352 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CJ

CPT Code: 81347 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2002CK

CPT Code: 81305 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CL

CPT Codes: 81206, 81207 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CM

CPT Code: 81450 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CN

Comprehensive Sarcoma Fusion Profile) CPT Code: 81445 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CP

CPT Code: 0154U Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

2002CQ

CPT Code: 0018U Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

2002CR

CPT Code: 81279 Contract Period: Option Year 2 POP Begin: 10-01-2027 POP End: 09-30-2028

Option Year 3- 10/1/2028 to 09/30/2029

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

ANNUAL COST

Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3001AA

NAME:____________

TITLE:____________

Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3001AB

Pathologist On-Site

NAME:____________

TITLE:____________

Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

3001AC

Pathologist Off-Site Consultation

NAME:____________

TITLE:____________

Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3001AD

Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3001AE

Pathologist Call-Back

NAME:____________

TITLE:____________

Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3001AF

On-Call Pathology

NAME:____________

TITLE:____________

Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

3002AA

CPT Code: 81210 Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3002AB

CPT Code: 81219 Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3002AC

CPT Code: 81235 Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3002AD

CPT Code: 81270 Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3002AE

CPT Code: 81315 Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3002AF

CPT Code: 81342 Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

3002AG

CPT Code: 81479 Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3002AH

CPT Code: 85097 Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3002AJ

CPT Code: 88112-TC Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3002AK

CPT Code: 88172-TC Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3002AL

CPT Code: 88173-TC Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3002AM

CPT Code: 88177 Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

LIN No.

DESCRIPTION

OF SERVICES

ESTIMATED

QUANTITY UNIT UNIT COST

TOTAL ESTIMATED

3002AN

CPT Code: 88184-TC Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3002AP

CPT Code: 88185-TC Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029

3002AQ

CPT Code: 88237-TC Contract Period: Option Year 3 POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 621511 - Medica