Attachment C - Price Sheet - Pages 1-3.xlsx
XLSX spreadsheet 15 KB Posted
- Attached to
- Referral Lab Testing for CLSH-LDH
- Solicitation number
- 3000026810
- Issued by
- East Baton Rouge Parish, Baton Rouge City, Louisiana
About this file
Attachment C - Price Sheet for Referral Lab Testing for CLSH-LDH
This is a price sheet for referral laboratory testing services related to CLSH-LDH (Collaborative Laboratory for State Health-Laboratory Development and Health) in Louisiana. The document establishes pricing for laboratory testing services that will be provided to the state under the contract opportunity. The price sheet outlines the cost structure for various laboratory tests and services that the selected vendor will deliver as part of the referral lab testing program. The document serves as the financial component of the bid submission, requiring vendors to populate pricing information according to specified line items and testing categories detailed in the sheet.
The price sheet format allows vendors to propose their costs for the defined scope of laboratory testing services. Pricing terms would establish the financial obligations and payment structure between the state of Louisiana and the awarded vendor. This attachment is essential for evaluating vendor proposals on a cost basis and comparing the financial competitiveness of different bidders submitting responses to the referral lab testing opportunity.
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Table 1 Attachment C - Price Sheet RFx # 3000026810 - Referral Lab Testing for CLSH-LDH
| line # | Test Name | UOM | CPT Code | Test Code | Price | Turn Around Time | |
| 1 | Comprehensive Metabolic Panel | ||||||
| to include the following tests: Albumin, Calcium, Carbon Dioxide, Chloride, ALT, AST, BUN:Creatinine Ratio, Creatinine with GFR Estimated, Globulin, Glucose, Potassium, Sodium, Total Protein, Urea Nitrogen, Alkaline Phosphatase, Albumin:Globulin Ratio, Total Bilirubin | EA | 80053 | 9179 | ||||
| 2 | Basic Metabolic Panel | ||||||
| to include the following tests: BUN, Calcium, BUN:Creatinine Ratio, Creatinine with GFR Estimated, Glucose, Potassium, Sodium, Chloride, Carbon Dioxide | EA | 80048 | 142 | ||||
| 3 | Hepatic Function Panel | ||||||
| to include the following tests: Total Protein, Albumin, Globulin, Total Bilirubin, Direct Bilirubin, Indirect Bilirubin, Albumin: Globulin Ratio, Alkaline Phosphatase, AST, ALT | EA | 80076 | 9175 | ||||
| 4 | Valproic Acid (Depakote®), serum | EA | 80164 | 3094 | |||
| 5 | Lithium (Eskalith®), serum | EA | 80178 | 2128 | |||
| 6 | Rapid Plasma Reagin (RPR), Qualitative Test or VDRL | EA | 86592 | 3500 | |||
| 7 | Prolactin | EA | 84146 | 2800 | |||
| 8 | Thyroid‐Stimulating Hormone (TSH) | EA | 84443 | 2835 | |||
| 9 | Thyroxine (T4), Free, Direct | EA | 84439 | 2823 | |||
| 10 | Urinalysis, Routine (random) | EA | 81003 | 1501 | |||
| 11 | Carbamazepine, serum | EA | 80156 | 3025 | |||
| 12 | HIV‐1/O/2 Antibodies, Preliminary Test with Confirmation | EA | 86703 | 3540 | |||
| 13 | Triiodothyronine (T3), Free | EA | 84481 | 4273 | |||
| 14 | Lipid Panel | ||||||
| to include the following tests: Total Cholesterol, HDL Cholesterol, Triglycerides, LDL Cholesterol (calculated) | EA | 80061 | 173 | ||||
| 15 | Thyroid Panel with TSH | ||||||
| to include the following tests: T3 uptake (THBR), Free Thyroxine Index, Thyroxine (T4), Thyroid‐ Stimulating Hormone (TSH) | EA | 84436, |
8444,
| 84479 | 119 | ||||
| 16 | Thyroxine(T4) | EA | 84436 | 2819 | |
| 17 | Hemoglobin (Hb) A1C | EA | 83036 | 2708 | |
| 18 | Pregnancy Test Urine | EA | 81025 | 1540 | |
| 19 | Complete Blood Count (CBC) with Differential and Platelet Count | EA | 85025 | 1000 | |
| 20 | Vitamin B12 and Folate | EA | 82607, | ||
| 82746 | 2955 | ||||
| 21 | T3 Uptake (THBR) | EA | 84479 | 2817 | |
| 22 | Lipase, serum | EA | 83690 | 2124 | |
| 23 | Triiodothyronine (T3) | EA | 84480 | 2818 | |
| 24 | Testosterone, Total, serum | EA | 84403 | 2830 | |
| 25 | Amylase, serum | EA | 82150 | 2025 | |
| 26 | Folate (Folic Acid), serum | EA | 82746 | 2695 | |
| 27 | Urine Culture, Routine | EA | 87086 | 6049 | |
| 28 | Sedimentation Rate, Modified Westergren | EA | 85652 | 1055 | |
| 29 | Prothrombin Time (PT) with INR | EA | 85610 | 1425 | |
| 30 | Ferritin, serum | EA | 82728 | 2090 | |
| 31 | Vitamin B12 | EA | 82607 | 2840 | |
| 32 | Carcinoembryonic Antigen (CEA) | EA | 82378 | 2645 | |
| 33 | Prostate‐Specific Antigen (PSA), Serial Monitor | EA | 84153 | 2606 | |
| 34 | Hepatitis B Surface Antibodies, Qualitative | EA | 86706 | 2737 | |
| 35 | Ammonia, plasma | EA | 82140 | 2020 | |
| 36 | Phenytoin (Dilantin®), serum | EA | 80185 | 3064 | |
| 37 | Clozapine (Clozaril®), serum | EA | 80159 | 5825 | |
| 38 | Oxcarbazepine | EA | 80183 | 5239 | |
| 39 | Vitamin D, 25‐Hydroxy | EA | 82306 | 4958 | |
| 40 | Prothrombin Time and Partial Thromboplastin Time (PT | ||||
| & PTT) | EA | 85610, | |||
| 85730 | 1401 | ||||
| 41 | Acute Hepatitis Panel, to include the following tests: Hepatitis B Core Antibody, IgM; Hepatitis B Surface Antigen, Hepatitis C Antibody; Hepatitis A Antibody, IgM | EA | 80074 | 9325 | |
| 42 | Testosterone, Free, Direct with Total Testosterone | EA | 84402, | ||
| 84403 | 4937 | ||||
| 43 | Thyroid‐stimulating Hormone (TSH) and Free T4 | EA | 84439, | ||
| 84443 | 2836 | ||||
| 44 | Carcinoembryonic Antigen (CEA), Serial Monitor | EA | 82378 | 2645 | |
| 45 | Phenytoin (Dilantin®), Free and Total, serum | EA | 80185, | ||
| 80186 | 5940 | ||||
| 46 | Blood Culture, Routine | EA | 87040 | 6013 | |
| 47 | Glucose, plasma serum | EA | 82947 | 2217 | |
| 48 | Hep B Virus (HBV)* | EA | 87517 | 4286 | |
| 49 | Hep B Core Antibody, IgM* | EA | 86705 | 4644 | |
| 50 | HGB, serum (Sickle Cell Screen) | EA | 85660 | 3520 | |
| 51 | CBC w/Diff (no Platelet) | EA | 85004, |
85014, 85018, 85041,
| 85048 | 1000 | ||||
| 52 | Manganese | EA | 83785 | 4243 | |
| 53 | Varicella Igg | EA | 86787 | 4665 | |
| 54 | ANA with reflex titer | EA | 86038 | 3550 | |
| 55 | ANA w/Reflex if Positive (reflex to mult cpt) | EA | 86038 | 3550 | |
| 56 | Hepatitis Panel, to include the following tests: HBcAb, HBsAb, Ag, HCVAb | EA | 80074 | 9325 | |
| 57 | Chain‐of‐Custody Protocol, Specimen | EA | 99199 | ||
| 58 | Stat Testing ‐ As needed/requested ‐ Vendor must contact Agency by telephone upon completion of request within 3 hours of receiving test | EA | 923 | ||
| 59 | Draw Fee (Venipuncture) ‐ As needed/requested | EA |
File details come from the government source that posted it. Updated .