Bid Form SHC Lab Service IFB OCMP-26-25349.xlsx

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Attached to
Services -OCMP-26-25349 Laboratory Services for Springfield Hospital Center
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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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 costsOption 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 TESTSMNEMONICCPT CODEYear 1 QtyPRICE PER TESTYear 1 CostsOption Period 1
QtyPRICE PER TESTOption Period 1 CostsTotal Costs
Acetylcholine Blocking & Modulat8351900
ACTH701132218202422
Ammonia70142038821408185
Basic Metabolic Panel (BMP)7014220080048479481
Beta-2 Microglobulin701452918223200
BUN701420238452057
Carbamazapine Level (Tegretol)70142082801561919
CBC701320898502556235626
Clozapine7011314180159802802
Comp Metabolic Panel (CMP)701422018005332593262
Conf-Drugs Abuse701150598034500
C Peptide701131088468100
Creatinine701420248256557
Direct Bilirubin701420628224800
Electrolytes70142015800512024
Erythropoietin701130428266833
Factor V Gene Analysis701171428124100
Ferritin7014207682728137141
Free Kappa & Lambda for K/L ratio70115799838831010
Glucose70142018829476669
HCG Qual70142010847039090
Hemogram 3701320658502700
HGB A1C701430398303619211921
HIV-I RNA, VIRAL LOAD70115176875362732
Leuk/Lymph Eval701155478818400
Lipid Panel701420698006118221822
Lithium7014302280178834834
Liver Panel7014201480076130130
Magnesium70142061837355353
Man Diff Only701320878500700
Metanephrines701130648383511
Myoglobin, Serum701131798387411
Occult Blood, Fecal70154254822709494
Opiate Confirmation701171338254100
Prothrombin Time7013107586510110110
REC Assay Non-Endo (eg acetly)8423800
RPR (Rapid Plasma Reagin)7015400186592401401
Smooth Muscle Antibody701153878351611
Somatomedin701151298430500
T3 Free70145008844812222
T4 Thyroxine Total7014206384436240240
T4 Thyroxine Free7014302384439160160
Testosterone, Free70113071844021818
TSH (Thyroid Stim Hormone)701420998444316681668
Urine Culture7015410587086146149
Urine Group, w/o Microscopy701420048100300
Urine, Routine w/Microscopy7014200181001705705
Valproic Acid (Depakene)701420838016418671867
Vitamin B-127014207282607299299
Vitamin D 25 Hydrox Quest7011712982306338338
17 Hydroxy Progesterone7011318000
ACE7011309200
Rec Assay Non-Endo (eg Acetyl)7011308500
Aerobic Culture701541992224
Anaerobic Culture7015419568
Albumin701420528204000
Aldolase7011303300
Aldosterone Serum7011305933
Alkaline Phosphatase701420538407500
Alk Phos Isoenzyme7011300435
Clam Allergen IGE7011572755
Banana Allergen IGE7011581755
Codfish Allergen IGE7011572355
Shrimp Allergen IGE7011572555
Salmon IGE7011584055
Alpha 1 Antitrypsin7014528700
Alpha 1 Fetoprotein701130344146
Amitriptyline7011309134
Amylase70142056856513739
ANA Choice Reflex7011709188
Arsenic7011510400
Ascorbic Acid7011521300
ATB Screen RBC, EA Technique7019600100
Anti-Body Treponema Pallidum7015429900
Anti Centomere B AB7011580600
Anti DNA7011306155
Anti Islet Cell Antibody7011306111
Anti Nuclear Antibody701453033536
Antithy Microsomal AB7011508200
Athena ANA7015426600
Automated ESR70132090856516365
Beta Lactamase7015431000
Bilirubin Total7014202200
Blood Typing, ABO7019610400
Blood Typing, RH(D)7019601300
Compatibility, Antiglob Techni7019612000
IMM Spin Crossmatch7019603700
Unit ABO Recheck7019901800
Leuko Reduced RBC ARC Proces7100901900
C React Protein Quan (CRP)70142087364366
C. Difficile Toxin Probe7015429233
Calcitonin7011303700
Calcium7014203046
Calprotectin Stool7011716800
Campy EIA7015428500
Cancer Antigen 19.9 Quaint7014529400
Carbon Dioxide7014204200
Carnitine, Serum7011519400
Catacholamine, Fractionated7011308600
CD2 Marker7011570100
CD3 Marker7011570233
CD4 Marker7011570300
CD5 Marker7011570400
CD7 Marker7011570500
CD8 Marker7011570633
CD10 Marker7011570700
CD11C Marker7011570800
CD19 Marker7011571000
CD20 Marker7011571100
CD23 Marker7011571200
CD33 Marker7011571300
CD34 Marker7011571400
CD38 Marker7011571500
CD56 Marker7011571600
CD64 Marker7011571700
CD117 Marker7011571800
HLA-DR Marker7011571900
sKAPPA Marker7011572000
sLAMBDA Marker7011572100
CEA70142093810
Celiac Gammaglob IGA7011585200
Cell Block7012535900
Ceruloplasmin7011506100
Ceruloplasmin7011531300
Chloride7014204100
Cholesterol7014203200
Chromatin AB7011771200
Chrom,Quan,Col,No(Fluphenazine)7011517000
Complement C47014531255
Total Complement7011305155
Coombs Test Direct, Polyspecific7019600211
Copper, Serum7011311255
Cortisol7014207055
Cortisol, Urine7011310200
Creatinine Clear 24HR7014205100
Creatinine phosphokinase (CPK)70142025825503636
Creatine kinase MB (CK MB)7014221600
Creatinine Random Urine7014203755
Cryptosporidium EIA7015423800
Cyto Sputum7012500400
DHEA-S7011307400
Digoxin701420658016200
ENV Culture701541968707000
Estradiol701430198267066
Extract Nuclear Antigen Antibody7011318800
Extract Nuclear Antigen Antibody7011319100
Extract Nuclear Antigen Antibody7011319200
Extract Nuclear Antigen Antibody7011319300
Extract Nuclear Antigen Antibody7011526300
Factor V Assay7011525922
Fecal Fat Qual7011777822
Fibrinogen7013208322
Flor AB Screen7011601700
Fluoro Antibody Screen, EA Anti7011317400
Folate7014220382746125125
Folate RBC7011315200
FREE KAPPA7014531700
FREE LAMBDA7014531800
FSH70143032830012932
Fungal Smear7015413911
Fungus Culture7015405011
GGTP701420808297755
Giardia EIA7015423700
Gliadin IGG7011713400
Gliadin IGA7011713500
Glucose (Nonfasting)701450003540
Glutamic Acid Decarboxylase7011775700
Glycohemoglobin, HBA1C70110390110115
Gram Stain7015404400
H Pylori Stool7015429657
Haldoperidol701153896060
Haptoglobin701152071313
HCG Quan701420814345
HCT7013102000
Hemoglobin Electrophoresis701177181010
Hemoglob Fract & Quant Electroph7011300344
Hepatitis-Acute Panel701130188007423
Hepatitis A Antibody70113126200200
Hepatitis B Surface Antibody7011308286706300300
Hepatitis B Surface Antigen70154256300300
Hepatitis B E Antigen7011312856
Hepatitis B Surface AB701453008990
Hepatitis B Surface AG7014530500
Hep C ATB7011310686803300300
Hep C Quantification701151017676
HGB7013101900
HGH Growth Hormone7011305300
Homocysteine7013316900
Ident Org ID701541118707700
IGA7014213055
IGG7014213100
IgG Subclass 17011538300
IgG Subclass 27011538400
IgG Subclass 37011538500
IgG Subclass 47011538600
IGM7014212900
Ionized Calcium7014501122
Immunoassay, Non-Infec, Multi-St7011509900
Immunoassay, Not Otherwise Spec7011310700
Immunoelectrophoresis UR Serum701421151414
Immunoelectrophoresis Urine701452721010
Inhibin A7011552100
Inhibin B7011764700
Insulin7011301311
Intrinsic Factor Blocking AB7011541800
Iron70142028112112
JO - A+B7011505000
Kirby Bauer Gram Negative Panel7015410800
Lactic Acid7014209800
Lactimal70116001?00
Lamotrigine7011767322
LDH701420261010
Lead7011302822
Legionella UR AG7015421700
Levatiracetam701176741313
Levetiracetum (Kepra) level70115412?00
Leuko Stool7015425822
Liat Flu Influenza Test7015430100
LIATSS - Rapid Strep7015430000
Lipase70142045?2222
Liver Fibrosis701178244040
Luteinizing Hormone70143054?2222
Mercury, Blood7011504300
Metanephrines7011306422
Methylmalonic Acid7011317522
Micro Broth Concen7015428800
Micro Pneumonoccal Panel7015416944
Mic Gram Negative Panel701541078717600
Microsomial Antibody (Thyroid)701452801515
Mitochondrial M2 Antibody7011774100
Mumps7011415100
Mumps70145302?00
Myeloperoxidase AB7011713700
Myoglobin Quantitative7011302100
Nortriptyline7011313234
Occult Blood7015403488
Olanzapine Level6060
Organic Acid Single Quant7011781900
Osmality Serum7014204655
Osmality Urine7014200855
Oxcarbazepine701176754650
Pantothenic Acid (B-5)7011522100
Parathyroid Hormone, Intact7014397033
Phenytoin701420778018500
Phenytoin Free7011315300
Phosphorus70142031841003030
Platelet Count7013102100
POC GASOCB7011710000
Porphyrins7011549311
Potassium701420408413200
Prealbumin7014211200
Pro BNP7011713255
Procalcitonin (PCT)70148474500
Progesterone7014502222
Proinsulin7011536800
Prolactin70143063841466161
Prostatic Spec Antigen (PSA)70143083249249
PSA, Screen70145270128128
Protein Elec701420661010
Protein Elect, Urine7014308100
Protein, 24 hr8415600
Proteinase-3 AB7011713600
PTH RP7011588400
Ref Lab Misc (Abilify Level)7011300000
Ref Lab Misc (Arylsulfatase)7011300000
Ref Lab Misc (HIV)7011300044
Ref Lab Misc (ANA)7011300000
Ref Lab Misc (Aripiprazole, Quant)701130001515
Ref Lab Misc (Proinsulin)701130008029900
Ref Lab Misc (Olanzapine)70113000802991111
Ref Lab Misc (Fluphenazine)701130001113
Ref Lab Misc (Luvox Level)7011300000
Ref Lab Misc (Perphenazine)7011300000
Ref Lab Misc (Anafranil)7011300000
Ref Lab Misc (Haloperidol)701130003335
Ref Lab Misc (Synthetic Cannabinoid)7011300000
Ref Lab Misc (Carb Defic Transferrin)7011300000
Ref Lab Misc (RPR)7011300000
Ref Lab Misc (Vistaril level-Hydroxyzine)7011300000
Ref Lab Misc (CYP2D6 Gene Testing)7011300011
Ref Lab Misc (CYP450 2D6)7011300000
Ref Lab Misc (CYP1A2)7011300011
Ref Lab Misc (CYP3A4)7011300011
Ref Lab Misc (Vitamin B6)7011300000
Ref Lab Misc (Haldol level))7011300000
Ref Lab Misc (Clozapine Level)7011300000
Ref Lab Misc (Paroxitene)7011300000
Ref Lab Misc (Free Phenytoin/Dilantin)701130001515
Ref Lab Misc (Quetiapine Level)7011300000
Ref Lab Misc (Urine Tox Screen)7011300000
Ref Lab Misc (Zyprexa Level)7011300000
Ref Lab Misc (Fecal Fat Qual)7011300000
Ref Lab Misc (Prolactin Study)7011300000
Ref Lab Misc (Allergen IDE +41)7011300000
Ref Lab Misc (Hymenoptera Profile)7011300000
Ref Lab Misc (Carbamazepine Tox)701130001215
Ref Lab Misc (Fish VCFS)7011300000
Ref Lab Misc (Huntington's)7011300000
Ref Lab Misc (VDRL)7011300000
Ref Lab Misc (VPA level (Depakote))7011300000
Ref Lab Misc (Resperidal Level)7011300000
Ref Lab Misc (Serum Tox Screen)7011300000
Ref Lab Misc (Trazadone Level)7011300000
Ref Lab Misc (Chlomipramine)701130001212
Ref Lab Misc (Quantiferon Gold)70113000304304
Ref Lab Misc (Syphilis)7011300000
Ref Lab Misc (Risperidone)701130003636
Ref Lab Misc (N Methyl D Aspartate Receptor Antibody)7011300022
Ref Lab Misc (Mumps)7011300000
Ref Lab Misc (Prolixin Level)7011300000
Ref Lab Misc (Serum Cholinesterase)7011300000
Ref Lab Misc (Urine IFE)7011300000
Ref Lab Misc (Geodon level)7011300000
Ref Lab Misc (Trilafon level)7011300000
Ref Lab Misc (heavy metals)7011300022
Ref Lab Misc (Rubella)7011300000
Ref Lab Misc (Genetic Hemochrom)7011300000
Ref Lab Misc (serum drugs of abuse)7011300000
Ref Lab Misc (urine drugs of abuse)7011300000
Ref Lab Misc (Alphaglobulin)7011300000
Ref Lab Misc (Serum Osmality)7011300000
Ref Lab Misc (Urine Osmality)7011300000
Ref Lab Misc (Paloperidone Level)7011300022
Ref Lab Misc (Ziprazidone Level)7011300000
Ref Lab Misc (Fungitell (R1-3))7011300000
Ref Lab Misc (Aspergillus)7011300000
Ref Lab Misc (Not yet Indentified)7011300000
Ref Lab Misc (Legionella Pneum AB IgM)7011300000
Ref Lab Misc (Rickettsia Disease)7011300000
Ref Lab Misc (RT PCR BCR Abl)7011300000
Ref Lab Misc (Thorazine level)7011300000
Ref Lab Misc (Seroquel level)7011300055
Ref Lab Misc (Serum HCV Genotyping)701130001417
Ref Lab Misc (HCV Antibody Panel)7011300000
Ref Lab Misc (HCV RNA)701130001925
Renal Panel701450068006922
Renin7011208533
Resp Virus 12-25 Targets70118763344
Reticulocyte70132088850441515
Rheu Factor Screen7015400399
RNP Antibody7011771100
RPR Quan7015400600
Rubella Antibody IgG7014527100
Rubeola7011409000
SARS-COV-2 RNA Qualtve RT-PCR7011876351010
SARS-COV-2 Antibody (IgG) Immu70148676922
SARS-COV-2 & Influ A&B Mul70158763600
SGOT (AST)7014202789
SGPT (ALT)7014203489
Shiga Toxin 17015428600
Shiga Toxin 27015428700
Sodium70142039?00
Somatomedin7011512900
Sputum Culture7015414922
Staph Screen for Pre-Op Patient7015429400
Stool Culture70154060810
Stool Pancreatic Elastase7011774022
Strep Screen Rapid7015419400
Strep Throat Culture7015407400
T3U T3 Uptake701422178447900
Testosterone, Total70142225844031313
Theophylline7014209500
Theophylline level7011781600
Thiamine (Vit B1)7011319700
Throat Culture701542511515
Thromboplastin Time (APTT)701310028585
Thyroglobulin7014527900
Thyroglobulin Antibody701452781212
Thyroglobulin Antibody7011306200
Thyrotrop Binding Inhibit7011773900
Tissue Transglutaminase7011315055
Topiramate7011542100
Total Protein701420291010
Total T3701450098448000
Toxoplasma Gondii IgG Antibody7011526122
Transferrin7014222400
Treponema Pallidum Antibody7011778100
Triglyceride7014203500
Troponin70143084206206
Tuberculosis Test70117834304304
Uric Acid70142033845501313
Urine, Phosphorus 24hr7014205900
Urine, Random Creatinine701420371010
Urine, Random Sodium7014213600
Urine, Random Potassium7015213500
Urine, Random Chloride7014213400
Urine Microscopy701420038101500
Urine, w/o Microscopy701420048100300
Urine, Microalbumin701421178787
Urine, Protein701452611010
Urine Ran Porphobilino70110052111
Vaginal Culture7015414746
Varicella Antibody7011415011
Varicella Zoster7011504911
Viral Test Serology (HIV)7015417100
Vitamin B-67011504800
Vitamin D 25 Hydroxy701542896060
Vitamin D 125 Dihydroxy7011321222
Vitamin E7011520433
Zinc7011314033
Alcohol7014207400
Antidiuretic Hormone7011521200
Blood Culture w/ARD7015425546
BNP-Type Natriutic Peptide7014526923
CA 1257014502000
Chlam AB Trach OGG7011555500
Chlamydia Trach,DNA,AMP Probe701151614040
Chlamydia Pneu IGA7011549900
Chlamydia Pneu IGG7011549100
Chlamydia Pneu IGM7011550100
Chlamydia PSIT IGA7011552000
Chlamydia PSIT IGG7011549800
Chlamydia PSIT IGM7011549500
Chlamydia Trac IGA7011551900
Chlamydia Trac IGM7011550000
Clam DNA Amp Probe7015428200
D-Dimer7013104700
D-Dimer, Quant7013209177
Drugs of Abuse Screen7014528524
Drugs of Abuse Screen7014528600
Ear Culture/Gram Stain701541631020
Eye Culture7015406100
FTA-ABS Serum701140111515
G6PD7011302422
GC DNA Amp Probe701542814040
Genotype by Nuc Acid, Hepat C701120863333
H. Pylori Antibody7015416635
Hepatitus A Antibody IGM7011717700
Hepatitus B Core Anti, IGM7011312533
Hepatitus B Core Antibody7011312435
Hepatitus C Antibody7011714000
Herpes Simplex 17011580700
Herpes Simplex 27011580800
Herpes Simplex Type 17011315800
Herpes Simplex Type17011316100
HIV Antibody70145307270270
HIV 1/2 Antibodies7015429700
HIV 2 Antibody7011766900
HIV Antibody Detection (Ref)7011417200
HIV P24 Antigen7014530800
HIV P24 Antigen7015429800
HIV AG/AB Combo (EIA)70145299110110
HSV 1 IGM TITER7011716600
HSV 2 IGM TITER7011716700
HSV IGG7011717100
HSV IGM7011717200
HSV 2 IGG7011601100
HSV 2 IGM7011717300
Influenza A701542342020
Influenza B701542332424
Lyme IGG Ab7011534722
Lyme IGM AB7011534822
Lymes EIA7015427935
Lymes IgG7014530100
Lymes IgM7014530600
Lymes (Borrelia Burgdor)7011407600
Lymph Subset CD4/CD8701155412325
MRSA Screen Culture701540718708177
MRSA Rapid7015430400
MSSA Rapid7015430300
Neis Gonorrh RNA7011554600
Syphilis7014530400
Syphilis Test, Quant7014531900
Toxo Screen Bld/Ur7011307655
Urine Amphetamine7014222600
Urine Barbituites7014222700
Urine Benzodiazipines7014222800
Urine Cocaine7014222900
Urine Drug Screen, Qual70145275518518
Urine Methadone7014223300
Urine Opiates7014223000
Urine PCP7014223100
Urine THC7014223200
Vanc Resistant Screen701540738708100
Forensic00
Laboratory00
Total Costs Per Column

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