Bid Form SHC Lab Service IFB OCMP-26-25349.xlsx
XLSX spreadsheet 45 KB Posted
- Solicitation number
- BPM057846
- Issued by
- Maryland
About this file
This is a Bid Form for laboratory services issued by the State of Maryland Department of Health (MDH) for Springfield Hospital Center (SHC) under Invitation for Bids (IFB) OCMP-26-25349. The procurement seeks laboratory services to support patient care at the state-operated facility. The bid form encompasses an extensive array of specialized laboratory tests organized by test type and corresponding CPT codes, including routine tests such as Complete Blood Counts (CBC), Comprehensive Metabolic Panels (CMP), and Lipid Panels, as well as specialized assays including drug level monitoring, immunological markers, microbiology cultures, and reference laboratory services. Bidders must provide pricing for Year 1 of the contract and an Option Period 1, with quantities specified for each test category ranging from single-digit to thousands of anticipated tests annually (for example, 5,623 CBC tests projected for Year 1 in one region). The bid form requires all unit prices and extended prices to be entered in dollars and cents with clear decimal points, and all calculations must be rounded to the nearest cent.
Bidders must submit fully loaded pricing that includes all labor, overhead, administrative expenses, and profit margins necessary to perform the contracted services, with no additional amounts payable to the contractor beyond the stated bid prices. All blank fields on the bid form must be completed, and any alterations or corrections must be initialed and dated by the bidder. The instructions explicitly prohibit alterations that propose conditions or contingencies on pricing, as such modifications may render the bid non-responsive. The State does not guarantee minimum or maximum utilization of any laboratory tests, and sample quantities used for bid evaluation purposes are estimates only. The contract award will be made on a single award basis to the successful bidder, though award does not guarantee the contractor will receive all or any State business under the contract. Bidders must provide pricing for both the initial year and the option renewal period as specified in the IFB.
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Text version
Instructions B-1 Bid Instructions
In order to assist each Bidder in the preparation of its Bid and to comply with the requirements of this solicitation, Bid Instructions and a Bid Form have been prepared. Each Bidder shall submit its Bid on the Bid Form in accordance with the instructions on the Bid Form and as specified herein. Do not alter the Bid Form or the Bid may be determined to be not responsive. The Bid Form is to be signed and dated, where requested, by an individual who is authorized to bind the Bidder to the prices entered on the Bid Form.
The Bid Form is used to calculate the Bidder’s TOTAL BID PRICE. Follow these instructions carefully when completing your Bid Form:
A) All Unit and Extended Prices must be clearly entered in dollars and cents, e.g., $24.15. Make your decimal points clear and distinct.
B) All Unit Prices must be the actual price per unit the State will pay for the specific item or service identified in this IFB and may not be contingent on any other factor or condition in any manner.
C) All calculations shall be rounded to the nearest cent, e.g., .344 shall be .34 and .345 shall be .35.
D) Any goods or services required through this IFB and proposed by the vendor at No Cost to the State must be clearly entered in the Unit Price, if appropriate, and Extended Price with $0.00.
E) Every blank in every Bid Form shall be filled in. Any changes or corrections made to the Bid Form by the Bidder prior to submission shall be initialed and dated.
F) Except as instructed on the Bid Form, nothing shall be entered on or attached to the Bid Form that alters or proposes conditions or contingencies on the prices. Alterations and/or conditions may render the Bid not responsive.
G) It is imperative that the prices included on the Bid Form have been entered correctly and calculated accurately by the Bidder and that the respective total prices agree with the entries on the Bid Form. Any incorrect entries or inaccurate calculations by the Bidder will be treated as provided in COMAR 21.05.02.12 and may cause the Bid to be rejected.
H) If option years are included, Bidders must submit pricing for each option year. Any option to renew will be exercised at the sole discretion of the State and comply with all terms and conditions in force at the time the option is exercised. If exercised, the option period shall be for a period identified in the IFB at the prices entered in the Bid Form.
I) All Bid prices entered below are to be fully loaded prices that include all costs/expenses associated with the provision of services as required by the IFB. The Bid price shall include, but is not limited to, all: labor, profit/overhead, general operating, administrative, and all other expenses and costs necessary to perform the work set forth in the solicitation. No other amounts will be paid to the Contractor. If labor rates are requested, those amounts shall be fully loaded rates; no overtime amounts will be paid.
J) Unless indicated elsewhere in the IFB, sample amounts used for calculations on the Bid Form are typically estimates for evaluation purposes only. Unless stated otherwise in the IFB, the Department does not guarantee a minimum or maximum number of units or usage in the performance of the Contract.
Summary
| Attachment B - Financial Proposal SHC Laboratory Services IFB OCMP | ||
| Year 1 costs | Option Period 1 costs | |
| Pricing | ||
| Total Cost Per Year |
TOTAL EVALUATED PROPOSED PRICE Table 1 - Summary Total
Name of Offeror:
Signature:
Date:
Address of Offeror:
Offeror FEIN:
Pricing
| Attachment B - Financial Proposal - SHC Laboratory Services IFB OCMP | |||||||
| Vendor: | |||||||
| Total Bid Cost for Region III | |||||||
| CONTRACTED SPECIALIZED TESTS | MNEMONIC | CPT CODE | Year 1 Qty | PRICE PER TEST | Year 1 Costs | Option Period 1 | |
| Qty | PRICE PER TEST | Option Period 1 Costs | Total Costs | ||||
| Acetylcholine Blocking & Modulat | 83519 | 0 | 0 | ||||
| ACTH | 70113221 | 82024 | 2 | 2 | |||
| Ammonia | 70142038 | 82140 | 81 | 85 | |||
| Basic Metabolic Panel (BMP) | 70142200 | 80048 | 479 | 481 | |||
| Beta-2 Microglobulin | 70145291 | 82232 | 0 | 0 | |||
| BUN | 70142023 | 84520 | 5 | 7 | |||
| Carbamazapine Level (Tegretol) | 70142082 | 80156 | 19 | 19 | |||
| CBC | 70132089 | 85025 | 5623 | 5626 | |||
| Clozapine | 70113141 | 80159 | 802 | 802 | |||
| Comp Metabolic Panel (CMP) | 70142201 | 80053 | 3259 | 3262 | |||
| Conf-Drugs Abuse | 70115059 | 80345 | 0 | 0 | |||
| C Peptide | 70113108 | 84681 | 0 | 0 | |||
| Creatinine | 70142024 | 82565 | 5 | 7 | |||
| Direct Bilirubin | 70142062 | 82248 | 0 | 0 | |||
| Electrolytes | 70142015 | 80051 | 20 | 24 | |||
| Erythropoietin | 70113042 | 82668 | 3 | 3 | |||
| Factor V Gene Analysis | 70117142 | 81241 | 0 | 0 | |||
| Ferritin | 70142076 | 82728 | 137 | 141 | |||
| Free Kappa & Lambda for K/L ratio | 70115799 | 83883 | 10 | 10 | |||
| Glucose | 70142018 | 82947 | 66 | 69 | |||
| HCG Qual | 70142010 | 84703 | 90 | 90 | |||
| Hemogram 3 | 70132065 | 85027 | 0 | 0 | |||
| HGB A1C | 70143039 | 83036 | 1921 | 1921 | |||
| HIV-I RNA, VIRAL LOAD | 70115176 | 87536 | 27 | 32 | |||
| Leuk/Lymph Eval | 70115547 | 88184 | 0 | 0 | |||
| Lipid Panel | 70142069 | 80061 | 1822 | 1822 | |||
| Lithium | 70143022 | 80178 | 834 | 834 | |||
| Liver Panel | 70142014 | 80076 | 130 | 130 | |||
| Magnesium | 70142061 | 83735 | 53 | 53 | |||
| Man Diff Only | 70132087 | 85007 | 0 | 0 | |||
| Metanephrines | 70113064 | 83835 | 1 | 1 | |||
| Myoglobin, Serum | 70113179 | 83874 | 1 | 1 | |||
| Occult Blood, Fecal | 70154254 | 82270 | 94 | 94 | |||
| Opiate Confirmation | 70117133 | 82541 | 0 | 0 | |||
| Prothrombin Time | 70131075 | 86510 | 110 | 110 | |||
| REC Assay Non-Endo (eg acetly) | 84238 | 0 | 0 | ||||
| RPR (Rapid Plasma Reagin) | 70154001 | 86592 | 401 | 401 | |||
| Smooth Muscle Antibody | 70115387 | 83516 | 1 | 1 | |||
| Somatomedin | 70115129 | 84305 | 0 | 0 | |||
| T3 Free | 70145008 | 84481 | 22 | 22 | |||
| T4 Thyroxine Total | 70142063 | 84436 | 240 | 240 | |||
| T4 Thyroxine Free | 70143023 | 84439 | 160 | 160 | |||
| Testosterone, Free | 70113071 | 84402 | 18 | 18 | |||
| TSH (Thyroid Stim Hormone) | 70142099 | 84443 | 1668 | 1668 | |||
| Urine Culture | 70154105 | 87086 | 146 | 149 | |||
| Urine Group, w/o Microscopy | 70142004 | 81003 | 0 | 0 | |||
| Urine, Routine w/Microscopy | 70142001 | 81001 | 705 | 705 | |||
| Valproic Acid (Depakene) | 70142083 | 80164 | 1867 | 1867 | |||
| Vitamin B-12 | 70142072 | 82607 | 299 | 299 | |||
| Vitamin D 25 Hydrox Quest | 70117129 | 82306 | 338 | 338 | |||
| 17 Hydroxy Progesterone | 70113180 | 0 | 0 | ||||
| ACE | 70113092 | 0 | 0 | ||||
| Rec Assay Non-Endo (eg Acetyl) | 70113085 | 0 | 0 | ||||
| Aerobic Culture | 70154199 | 22 | 24 | ||||
| Anaerobic Culture | 70154195 | 6 | 8 | ||||
| Albumin | 70142052 | 82040 | 0 | 0 | |||
| Aldolase | 70113033 | 0 | 0 | ||||
| Aldosterone Serum | 70113059 | 3 | 3 | ||||
| Alkaline Phosphatase | 70142053 | 84075 | 0 | 0 | |||
| Alk Phos Isoenzyme | 70113004 | 3 | 5 | ||||
| Clam Allergen IGE | 70115727 | 5 | 5 | ||||
| Banana Allergen IGE | 70115817 | 5 | 5 | ||||
| Codfish Allergen IGE | 70115723 | 5 | 5 | ||||
| Shrimp Allergen IGE | 70115725 | 5 | 5 | ||||
| Salmon IGE | 70115840 | 5 | 5 | ||||
| Alpha 1 Antitrypsin | 70145287 | 0 | 0 | ||||
| Alpha 1 Fetoprotein | 70113034 | 41 | 46 | ||||
| Amitriptyline | 70113091 | 3 | 4 | ||||
| Amylase | 70142056 | 85651 | 37 | 39 | |||
| ANA Choice Reflex | 70117091 | 8 | 8 | ||||
| Arsenic | 70115104 | 0 | 0 | ||||
| Ascorbic Acid | 70115213 | 0 | 0 | ||||
| ATB Screen RBC, EA Technique | 70196001 | 0 | 0 | ||||
| Anti-Body Treponema Pallidum | 70154299 | 0 | 0 | ||||
| Anti Centomere B AB | 70115806 | 0 | 0 | ||||
| Anti DNA | 70113061 | 5 | 5 | ||||
| Anti Islet Cell Antibody | 70113061 | 1 | 1 | ||||
| Anti Nuclear Antibody | 70145303 | 35 | 36 | ||||
| Antithy Microsomal AB | 70115082 | 0 | 0 | ||||
| Athena ANA | 70154266 | 0 | 0 | ||||
| Automated ESR | 70132090 | 85651 | 63 | 65 | |||
| Beta Lactamase | 70154310 | 0 | 0 | ||||
| Bilirubin Total | 70142022 | 0 | 0 | ||||
| Blood Typing, ABO | 70196104 | 0 | 0 | ||||
| Blood Typing, RH(D) | 70196013 | 0 | 0 | ||||
| Compatibility, Antiglob Techni | 70196120 | 0 | 0 | ||||
| IMM Spin Crossmatch | 70196037 | 0 | 0 | ||||
| Unit ABO Recheck | 70199018 | 0 | 0 | ||||
| Leuko Reduced RBC ARC Proces | 71009019 | 0 | 0 | ||||
| C React Protein Quan (CRP) | 70142087 | 364 | 366 | ||||
| C. Difficile Toxin Probe | 70154292 | 3 | 3 | ||||
| Calcitonin | 70113037 | 0 | 0 | ||||
| Calcium | 70142030 | 4 | 6 | ||||
| Calprotectin Stool | 70117168 | 0 | 0 | ||||
| Campy EIA | 70154285 | 0 | 0 | ||||
| Cancer Antigen 19.9 Quaint | 70145294 | 0 | 0 | ||||
| Carbon Dioxide | 70142042 | 0 | 0 | ||||
| Carnitine, Serum | 70115194 | 0 | 0 | ||||
| Catacholamine, Fractionated | 70113086 | 0 | 0 | ||||
| CD2 Marker | 70115701 | 0 | 0 | ||||
| CD3 Marker | 70115702 | 3 | 3 | ||||
| CD4 Marker | 70115703 | 0 | 0 | ||||
| CD5 Marker | 70115704 | 0 | 0 | ||||
| CD7 Marker | 70115705 | 0 | 0 | ||||
| CD8 Marker | 70115706 | 3 | 3 | ||||
| CD10 Marker | 70115707 | 0 | 0 | ||||
| CD11C Marker | 70115708 | 0 | 0 | ||||
| CD19 Marker | 70115710 | 0 | 0 | ||||
| CD20 Marker | 70115711 | 0 | 0 | ||||
| CD23 Marker | 70115712 | 0 | 0 | ||||
| CD33 Marker | 70115713 | 0 | 0 | ||||
| CD34 Marker | 70115714 | 0 | 0 | ||||
| CD38 Marker | 70115715 | 0 | 0 | ||||
| CD56 Marker | 70115716 | 0 | 0 | ||||
| CD64 Marker | 70115717 | 0 | 0 | ||||
| CD117 Marker | 70115718 | 0 | 0 | ||||
| HLA-DR Marker | 70115719 | 0 | 0 | ||||
| sKAPPA Marker | 70115720 | 0 | 0 | ||||
| sLAMBDA Marker | 70115721 | 0 | 0 | ||||
| CEA | 70142093 | 8 | 10 | ||||
| Celiac Gammaglob IGA | 70115852 | 0 | 0 | ||||
| Cell Block | 70125359 | 0 | 0 | ||||
| Ceruloplasmin | 70115061 | 0 | 0 | ||||
| Ceruloplasmin | 70115313 | 0 | 0 | ||||
| Chloride | 70142041 | 0 | 0 | ||||
| Cholesterol | 70142032 | 0 | 0 | ||||
| Chromatin AB | 70117712 | 0 | 0 | ||||
| Chrom,Quan,Col,No(Fluphenazine) | 70115170 | 0 | 0 | ||||
| Complement C4 | 70145312 | 5 | 5 | ||||
| Total Complement | 70113051 | 5 | 5 | ||||
| Coombs Test Direct, Polyspecific | 70196002 | 1 | 1 | ||||
| Copper, Serum | 70113112 | 5 | 5 | ||||
| Cortisol | 70142070 | 5 | 5 | ||||
| Cortisol, Urine | 70113102 | 0 | 0 | ||||
| Creatinine Clear 24HR | 70142051 | 0 | 0 | ||||
| Creatinine phosphokinase (CPK) | 70142025 | 82550 | 36 | 36 | |||
| Creatine kinase MB (CK MB) | 70142216 | 0 | 0 | ||||
| Creatinine Random Urine | 70142037 | 5 | 5 | ||||
| Cryptosporidium EIA | 70154238 | 0 | 0 | ||||
| Cyto Sputum | 70125004 | 0 | 0 | ||||
| DHEA-S | 70113074 | 0 | 0 | ||||
| Digoxin | 70142065 | 80162 | 0 | 0 | |||
| ENV Culture | 70154196 | 87070 | 0 | 0 | |||
| Estradiol | 70143019 | 82670 | 6 | 6 | |||
| Extract Nuclear Antigen Antibody | 70113188 | 0 | 0 | ||||
| Extract Nuclear Antigen Antibody | 70113191 | 0 | 0 | ||||
| Extract Nuclear Antigen Antibody | 70113192 | 0 | 0 | ||||
| Extract Nuclear Antigen Antibody | 70113193 | 0 | 0 | ||||
| Extract Nuclear Antigen Antibody | 70115263 | 0 | 0 | ||||
| Factor V Assay | 70115259 | 2 | 2 | ||||
| Fecal Fat Qual | 70117778 | 2 | 2 | ||||
| Fibrinogen | 70132083 | 2 | 2 | ||||
| Flor AB Screen | 70116017 | 0 | 0 | ||||
| Fluoro Antibody Screen, EA Anti | 70113174 | 0 | 0 | ||||
| Folate | 70142203 | 82746 | 125 | 125 | |||
| Folate RBC | 70113152 | 0 | 0 | ||||
| FREE KAPPA | 70145317 | 0 | 0 | ||||
| FREE LAMBDA | 70145318 | 0 | 0 | ||||
| FSH | 70143032 | 83001 | 29 | 32 | |||
| Fungal Smear | 70154139 | 1 | 1 | ||||
| Fungus Culture | 70154050 | 1 | 1 | ||||
| GGTP | 70142080 | 82977 | 5 | 5 | |||
| Giardia EIA | 70154237 | 0 | 0 | ||||
| Gliadin IGG | 70117134 | 0 | 0 | ||||
| Gliadin IGA | 70117135 | 0 | 0 | ||||
| Glucose (Nonfasting) | 70145000 | 35 | 40 | ||||
| Glutamic Acid Decarboxylase | 70117757 | 0 | 0 | ||||
| Glycohemoglobin, HBA1C | 70110390 | 110 | 115 | ||||
| Gram Stain | 70154044 | 0 | 0 | ||||
| H Pylori Stool | 70154296 | 5 | 7 | ||||
| Haldoperidol | 70115389 | 60 | 60 | ||||
| Haptoglobin | 70115207 | 13 | 13 | ||||
| HCG Quan | 70142081 | 43 | 45 | ||||
| HCT | 70131020 | 0 | 0 | ||||
| Hemoglobin Electrophoresis | 70117718 | 10 | 10 | ||||
| Hemoglob Fract & Quant Electroph | 70113003 | 4 | 4 | ||||
| Hepatitis-Acute Panel | 70113018 | 80074 | 2 | 3 | |||
| Hepatitis A Antibody | 70113126 | 200 | 200 | ||||
| Hepatitis B Surface Antibody | 70113082 | 86706 | 300 | 300 | |||
| Hepatitis B Surface Antigen | 70154256 | 300 | 300 | ||||
| Hepatitis B E Antigen | 70113128 | 5 | 6 | ||||
| Hepatitis B Surface AB | 70145300 | 89 | 90 | ||||
| Hepatitis B Surface AG | 70145305 | 0 | 0 | ||||
| Hep C ATB | 70113106 | 86803 | 300 | 300 | |||
| Hep C Quantification | 70115101 | 76 | 76 | ||||
| HGB | 70131019 | 0 | 0 | ||||
| HGH Growth Hormone | 70113053 | 0 | 0 | ||||
| Homocysteine | 70133169 | 0 | 0 | ||||
| Ident Org ID | 70154111 | 87077 | 0 | 0 | |||
| IGA | 70142130 | 5 | 5 | ||||
| IGG | 70142131 | 0 | 0 | ||||
| IgG Subclass 1 | 70115383 | 0 | 0 | ||||
| IgG Subclass 2 | 70115384 | 0 | 0 | ||||
| IgG Subclass 3 | 70115385 | 0 | 0 | ||||
| IgG Subclass 4 | 70115386 | 0 | 0 | ||||
| IGM | 70142129 | 0 | 0 | ||||
| Ionized Calcium | 70145011 | 2 | 2 | ||||
| Immunoassay, Non-Infec, Multi-St | 70115099 | 0 | 0 | ||||
| Immunoassay, Not Otherwise Spec | 70113107 | 0 | 0 | ||||
| Immunoelectrophoresis UR Serum | 70142115 | 14 | 14 | ||||
| Immunoelectrophoresis Urine | 70145272 | 10 | 10 | ||||
| Inhibin A | 70115521 | 0 | 0 | ||||
| Inhibin B | 70117647 | 0 | 0 | ||||
| Insulin | 70113013 | 1 | 1 | ||||
| Intrinsic Factor Blocking AB | 70115418 | 0 | 0 | ||||
| Iron | 70142028 | 112 | 112 | ||||
| JO - A+B | 70115050 | 0 | 0 | ||||
| Kirby Bauer Gram Negative Panel | 70154108 | 0 | 0 | ||||
| Lactic Acid | 70142098 | 0 | 0 | ||||
| Lactimal | 70116001 | ? | 0 | 0 | |||
| Lamotrigine | 70117673 | 2 | 2 | ||||
| LDH | 70142026 | 10 | 10 | ||||
| Lead | 70113028 | 2 | 2 | ||||
| Legionella UR AG | 70154217 | 0 | 0 | ||||
| Levatiracetam | 70117674 | 13 | 13 | ||||
| Levetiracetum (Kepra) level | 70115412 | ? | 0 | 0 | |||
| Leuko Stool | 70154258 | 2 | 2 | ||||
| Liat Flu Influenza Test | 70154301 | 0 | 0 | ||||
| LIATSS - Rapid Strep | 70154300 | 0 | 0 | ||||
| Lipase | 70142045 | ? | 22 | 22 | |||
| Liver Fibrosis | 70117824 | 40 | 40 | ||||
| Luteinizing Hormone | 70143054 | ? | 22 | 22 | |||
| Mercury, Blood | 70115043 | 0 | 0 | ||||
| Metanephrines | 70113064 | 2 | 2 | ||||
| Methylmalonic Acid | 70113175 | 2 | 2 | ||||
| Micro Broth Concen | 70154288 | 0 | 0 | ||||
| Micro Pneumonoccal Panel | 70154169 | 4 | 4 | ||||
| Mic Gram Negative Panel | 70154107 | 87176 | 0 | 0 | |||
| Microsomial Antibody (Thyroid) | 70145280 | 15 | 15 | ||||
| Mitochondrial M2 Antibody | 70117741 | 0 | 0 | ||||
| Mumps | 70114151 | 0 | 0 | ||||
| Mumps | 70145302 | ? | 0 | 0 | |||
| Myeloperoxidase AB | 70117137 | 0 | 0 | ||||
| Myoglobin Quantitative | 70113021 | 0 | 0 | ||||
| Nortriptyline | 70113132 | 3 | 4 | ||||
| Occult Blood | 70154034 | 8 | 8 | ||||
| Olanzapine Level | 60 | 60 | |||||
| Organic Acid Single Quant | 70117819 | 0 | 0 | ||||
| Osmality Serum | 70142046 | 5 | 5 | ||||
| Osmality Urine | 70142008 | 5 | 5 | ||||
| Oxcarbazepine | 70117675 | 46 | 50 | ||||
| Pantothenic Acid (B-5) | 70115221 | 0 | 0 | ||||
| Parathyroid Hormone, Intact | 70143970 | 3 | 3 | ||||
| Phenytoin | 70142077 | 80185 | 0 | 0 | |||
| Phenytoin Free | 70113153 | 0 | 0 | ||||
| Phosphorus | 70142031 | 84100 | 30 | 30 | |||
| Platelet Count | 70131021 | 0 | 0 | ||||
| POC GASOCB | 70117100 | 0 | 0 | ||||
| Porphyrins | 70115493 | 1 | 1 | ||||
| Potassium | 70142040 | 84132 | 0 | 0 | |||
| Prealbumin | 70142112 | 0 | 0 | ||||
| Pro BNP | 70117132 | 5 | 5 | ||||
| Procalcitonin (PCT) | 701484745 | 0 | 0 | ||||
| Progesterone | 70145022 | 2 | 2 | ||||
| Proinsulin | 70115368 | 0 | 0 | ||||
| Prolactin | 70143063 | 84146 | 61 | 61 | |||
| Prostatic Spec Antigen (PSA) | 70143083 | 249 | 249 | ||||
| PSA, Screen | 70145270 | 128 | 128 | ||||
| Protein Elec | 70142066 | 10 | 10 | ||||
| Protein Elect, Urine | 70143081 | 0 | 0 | ||||
| Protein, 24 hr | 84156 | 0 | 0 | ||||
| Proteinase-3 AB | 70117136 | 0 | 0 | ||||
| PTH RP | 70115884 | 0 | 0 | ||||
| Ref Lab Misc (Abilify Level) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Arylsulfatase) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (HIV) | 70113000 | 4 | 4 | ||||
| Ref Lab Misc (ANA) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Aripiprazole, Quant) | 70113000 | 15 | 15 | ||||
| Ref Lab Misc (Proinsulin) | 70113000 | 80299 | 0 | 0 | |||
| Ref Lab Misc (Olanzapine) | 70113000 | 80299 | 11 | 11 | |||
| Ref Lab Misc (Fluphenazine) | 70113000 | 11 | 13 | ||||
| Ref Lab Misc (Luvox Level) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Perphenazine) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Anafranil) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Haloperidol) | 70113000 | 33 | 35 | ||||
| Ref Lab Misc (Synthetic Cannabinoid) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Carb Defic Transferrin) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (RPR) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Vistaril level-Hydroxyzine) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (CYP2D6 Gene Testing) | 70113000 | 1 | 1 | ||||
| Ref Lab Misc (CYP450 2D6) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (CYP1A2) | 70113000 | 1 | 1 | ||||
| Ref Lab Misc (CYP3A4) | 70113000 | 1 | 1 | ||||
| Ref Lab Misc (Vitamin B6) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Haldol level)) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Clozapine Level) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Paroxitene) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Free Phenytoin/Dilantin) | 70113000 | 15 | 15 | ||||
| Ref Lab Misc (Quetiapine Level) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Urine Tox Screen) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Zyprexa Level) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Fecal Fat Qual) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Prolactin Study) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Allergen IDE +41) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Hymenoptera Profile) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Carbamazepine Tox) | 70113000 | 12 | 15 | ||||
| Ref Lab Misc (Fish VCFS) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Huntington's) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (VDRL) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (VPA level (Depakote)) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Resperidal Level) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Serum Tox Screen) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Trazadone Level) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Chlomipramine) | 70113000 | 12 | 12 | ||||
| Ref Lab Misc (Quantiferon Gold) | 70113000 | 304 | 304 | ||||
| Ref Lab Misc (Syphilis) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Risperidone) | 70113000 | 36 | 36 | ||||
| Ref Lab Misc (N Methyl D Aspartate Receptor Antibody) | 70113000 | 2 | 2 | ||||
| Ref Lab Misc (Mumps) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Prolixin Level) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Serum Cholinesterase) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Urine IFE) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Geodon level) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Trilafon level) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (heavy metals) | 70113000 | 2 | 2 | ||||
| Ref Lab Misc (Rubella) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Genetic Hemochrom) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (serum drugs of abuse) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (urine drugs of abuse) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Alphaglobulin) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Serum Osmality) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Urine Osmality) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Paloperidone Level) | 70113000 | 2 | 2 | ||||
| Ref Lab Misc (Ziprazidone Level) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Fungitell (R1-3)) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Aspergillus) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Not yet Indentified) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Legionella Pneum AB IgM) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Rickettsia Disease) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (RT PCR BCR Abl) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Thorazine level) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (Seroquel level) | 70113000 | 5 | 5 | ||||
| Ref Lab Misc (Serum HCV Genotyping) | 70113000 | 14 | 17 | ||||
| Ref Lab Misc (HCV Antibody Panel) | 70113000 | 0 | 0 | ||||
| Ref Lab Misc (HCV RNA) | 70113000 | 19 | 25 | ||||
| Renal Panel | 70145006 | 80069 | 2 | 2 | |||
| Renin | 70112085 | 3 | 3 | ||||
| Resp Virus 12-25 Targets | 701187633 | 4 | 4 | ||||
| Reticulocyte | 70132088 | 85044 | 15 | 15 | |||
| Rheu Factor Screen | 70154003 | 9 | 9 | ||||
| RNP Antibody | 70117711 | 0 | 0 | ||||
| RPR Quan | 70154006 | 0 | 0 | ||||
| Rubella Antibody IgG | 70145271 | 0 | 0 | ||||
| Rubeola | 70114090 | 0 | 0 | ||||
| SARS-COV-2 RNA Qualtve RT-PCR | 701187635 | 10 | 10 | ||||
| SARS-COV-2 Antibody (IgG) Immu | 701486769 | 2 | 2 | ||||
| SARS-COV-2 & Influ A&B Mul | 701587636 | 0 | 0 | ||||
| SGOT (AST) | 70142027 | 8 | 9 | ||||
| SGPT (ALT) | 70142034 | 8 | 9 | ||||
| Shiga Toxin 1 | 70154286 | 0 | 0 | ||||
| Shiga Toxin 2 | 70154287 | 0 | 0 | ||||
| Sodium | 70142039 | ? | 0 | 0 | |||
| Somatomedin | 70115129 | 0 | 0 | ||||
| Sputum Culture | 70154149 | 2 | 2 | ||||
| Staph Screen for Pre-Op Patient | 70154294 | 0 | 0 | ||||
| Stool Culture | 70154060 | 8 | 10 | ||||
| Stool Pancreatic Elastase | 70117740 | 2 | 2 | ||||
| Strep Screen Rapid | 70154194 | 0 | 0 | ||||
| Strep Throat Culture | 70154074 | 0 | 0 | ||||
| T3U T3 Uptake | 70142217 | 84479 | 0 | 0 | |||
| Testosterone, Total | 70142225 | 84403 | 13 | 13 | |||
| Theophylline | 70142095 | 0 | 0 | ||||
| Theophylline level | 70117816 | 0 | 0 | ||||
| Thiamine (Vit B1) | 70113197 | 0 | 0 | ||||
| Throat Culture | 70154251 | 15 | 15 | ||||
| Thromboplastin Time (APTT) | 70131002 | 85 | 85 | ||||
| Thyroglobulin | 70145279 | 0 | 0 | ||||
| Thyroglobulin Antibody | 70145278 | 12 | 12 | ||||
| Thyroglobulin Antibody | 70113062 | 0 | 0 | ||||
| Thyrotrop Binding Inhibit | 70117739 | 0 | 0 | ||||
| Tissue Transglutaminase | 70113150 | 5 | 5 | ||||
| Topiramate | 70115421 | 0 | 0 | ||||
| Total Protein | 70142029 | 10 | 10 | ||||
| Total T3 | 70145009 | 84480 | 0 | 0 | |||
| Toxoplasma Gondii IgG Antibody | 70115261 | 2 | 2 | ||||
| Transferrin | 70142224 | 0 | 0 | ||||
| Treponema Pallidum Antibody | 70117781 | 0 | 0 | ||||
| Triglyceride | 70142035 | 0 | 0 | ||||
| Troponin | 70143084 | 206 | 206 | ||||
| Tuberculosis Test | 70117834 | 304 | 304 | ||||
| Uric Acid | 70142033 | 84550 | 13 | 13 | |||
| Urine, Phosphorus 24hr | 70142059 | 0 | 0 | ||||
| Urine, Random Creatinine | 70142037 | 10 | 10 | ||||
| Urine, Random Sodium | 70142136 | 0 | 0 | ||||
| Urine, Random Potassium | 70152135 | 0 | 0 | ||||
| Urine, Random Chloride | 70142134 | 0 | 0 | ||||
| Urine Microscopy | 70142003 | 81015 | 0 | 0 | |||
| Urine, w/o Microscopy | 70142004 | 81003 | 0 | 0 | |||
| Urine, Microalbumin | 70142117 | 87 | 87 | ||||
| Urine, Protein | 70145261 | 10 | 10 | ||||
| Urine Ran Porphobilino | 701100521 | 1 | 1 | ||||
| Vaginal Culture | 70154147 | 4 | 6 | ||||
| Varicella Antibody | 70114150 | 1 | 1 | ||||
| Varicella Zoster | 70115049 | 1 | 1 | ||||
| Viral Test Serology (HIV) | 70154171 | 0 | 0 | ||||
| Vitamin B-6 | 70115048 | 0 | 0 | ||||
| Vitamin D 25 Hydroxy | 70154289 | 60 | 60 | ||||
| Vitamin D 125 Dihydroxy | 70113212 | 2 | 2 | ||||
| Vitamin E | 70115204 | 3 | 3 | ||||
| Zinc | 70113140 | 3 | 3 | ||||
| Alcohol | 70142074 | 0 | 0 | ||||
| Antidiuretic Hormone | 70115212 | 0 | 0 | ||||
| Blood Culture w/ARD | 70154255 | 4 | 6 | ||||
| BNP-Type Natriutic Peptide | 70145269 | 2 | 3 | ||||
| CA 125 | 70145020 | 0 | 0 | ||||
| Chlam AB Trach OGG | 70115555 | 0 | 0 | ||||
| Chlamydia Trach,DNA,AMP Probe | 70115161 | 40 | 40 | ||||
| Chlamydia Pneu IGA | 70115499 | 0 | 0 | ||||
| Chlamydia Pneu IGG | 70115491 | 0 | 0 | ||||
| Chlamydia Pneu IGM | 70115501 | 0 | 0 | ||||
| Chlamydia PSIT IGA | 70115520 | 0 | 0 | ||||
| Chlamydia PSIT IGG | 70115498 | 0 | 0 | ||||
| Chlamydia PSIT IGM | 70115495 | 0 | 0 | ||||
| Chlamydia Trac IGA | 70115519 | 0 | 0 | ||||
| Chlamydia Trac IGM | 70115500 | 0 | 0 | ||||
| Clam DNA Amp Probe | 70154282 | 0 | 0 | ||||
| D-Dimer | 70131047 | 0 | 0 | ||||
| D-Dimer, Quant | 70132091 | 7 | 7 | ||||
| Drugs of Abuse Screen | 70145285 | 2 | 4 | ||||
| Drugs of Abuse Screen | 70145286 | 0 | 0 | ||||
| Ear Culture/Gram Stain | 70154163 | 10 | 20 | ||||
| Eye Culture | 70154061 | 0 | 0 | ||||
| FTA-ABS Serum | 70114011 | 15 | 15 | ||||
| G6PD | 70113024 | 2 | 2 | ||||
| GC DNA Amp Probe | 70154281 | 40 | 40 | ||||
| Genotype by Nuc Acid, Hepat C | 70112086 | 33 | 33 | ||||
| H. Pylori Antibody | 70154166 | 3 | 5 | ||||
| Hepatitus A Antibody IGM | 70117177 | 0 | 0 | ||||
| Hepatitus B Core Anti, IGM | 70113125 | 3 | 3 | ||||
| Hepatitus B Core Antibody | 70113124 | 3 | 5 | ||||
| Hepatitus C Antibody | 70117140 | 0 | 0 | ||||
| Herpes Simplex 1 | 70115807 | 0 | 0 | ||||
| Herpes Simplex 2 | 70115808 | 0 | 0 | ||||
| Herpes Simplex Type 1 | 70113158 | 0 | 0 | ||||
| Herpes Simplex Type1 | 70113161 | 0 | 0 | ||||
| HIV Antibody | 70145307 | 270 | 270 | ||||
| HIV 1/2 Antibodies | 70154297 | 0 | 0 | ||||
| HIV 2 Antibody | 70117669 | 0 | 0 | ||||
| HIV Antibody Detection (Ref) | 70114172 | 0 | 0 | ||||
| HIV P24 Antigen | 70145308 | 0 | 0 | ||||
| HIV P24 Antigen | 70154298 | 0 | 0 | ||||
| HIV AG/AB Combo (EIA) | 70145299 | 110 | 110 | ||||
| HSV 1 IGM TITER | 70117166 | 0 | 0 | ||||
| HSV 2 IGM TITER | 70117167 | 0 | 0 | ||||
| HSV IGG | 70117171 | 0 | 0 | ||||
| HSV IGM | 70117172 | 0 | 0 | ||||
| HSV 2 IGG | 70116011 | 0 | 0 | ||||
| HSV 2 IGM | 70117173 | 0 | 0 | ||||
| Influenza A | 70154234 | 20 | 20 | ||||
| Influenza B | 70154233 | 24 | 24 | ||||
| Lyme IGG Ab | 70115347 | 2 | 2 | ||||
| Lyme IGM AB | 70115348 | 2 | 2 | ||||
| Lymes EIA | 70154279 | 3 | 5 | ||||
| Lymes IgG | 70145301 | 0 | 0 | ||||
| Lymes IgM | 70145306 | 0 | 0 | ||||
| Lymes (Borrelia Burgdor) | 70114076 | 0 | 0 | ||||
| Lymph Subset CD4/CD8 | 70115541 | 23 | 25 | ||||
| MRSA Screen Culture | 70154071 | 87081 | 7 | 7 | |||
| MRSA Rapid | 70154304 | 0 | 0 | ||||
| MSSA Rapid | 70154303 | 0 | 0 | ||||
| Neis Gonorrh RNA | 70115546 | 0 | 0 | ||||
| Syphilis | 70145304 | 0 | 0 | ||||
| Syphilis Test, Quant | 70145319 | 0 | 0 | ||||
| Toxo Screen Bld/Ur | 70113076 | 5 | 5 | ||||
| Urine Amphetamine | 70142226 | 0 | 0 | ||||
| Urine Barbituites | 70142227 | 0 | 0 | ||||
| Urine Benzodiazipines | 70142228 | 0 | 0 | ||||
| Urine Cocaine | 70142229 | 0 | 0 | ||||
| Urine Drug Screen, Qual | 70145275 | 518 | 518 | ||||
| Urine Methadone | 70142233 | 0 | 0 | ||||
| Urine Opiates | 70142230 | 0 | 0 | ||||
| Urine PCP | 70142231 | 0 | 0 | ||||
| Urine THC | 70142232 | 0 | 0 | ||||
| Vanc Resistant Screen | 70154073 | 87081 | 0 | 0 | |||
| Forensic | 0 | 0 | |||||
| Laboratory | 0 | 0 | |||||
| Total Costs Per Column |
File details come from the government source that posted it. Updated .