Blood Bank Products Attachment A Final 1-13-2022.xlsx
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Ordering Year 1
| Ordering Year 1 4/1/2022 - 3/31/2023 | VISN 15 Blood Bank Products | ||||||||||||||
| TABLE 1 - BLOOD PRODUCTS | |||||||||||||||
| Line Items | BLOOD PRODUCTS, SERVICES, AND DELIVERY | FEE PER UNIT/SERVICE | Estimated Workload | ||||||||||||
| Kansas City VAMC | Estimated Workload Leavenworth VAMC | Estimated Workload Topeka VAMC | Estimated Workload Columbia VAMC | Estimated Workload Marion VAMC | Poplar Bluff VAMC | Estimated Workload St. Louis VAMC | Estimated Workload Wichita VAMC | VISN 15 GRAND TOTAL WORKLOAD | VISN 15 GRAND TOTAL COSTS | ||||||
| 0001 | 24 Hour Plasma | $0.00 | 350 | 7 | 15 | 372 | $0.00 | ||||||||
| 0002 | AB Cryo Surcharge | 175 | 175 | $0.00 | |||||||||||
| 0003 | AB Plasma Surcharge | 12 | 4 | 1 | 2 | 19 | $0.00 | ||||||||
| 0004 | Apheresis Platelets - Pathogen Reduced (SDP-PR) | 99 | 260 | 22 | 25 | 75 | 20 | 501 | $0.00 | ||||||
| 0005 | Apheresis Platelets (SDP LVDS) | 90 | 12 | 5 | 107 | $0.00 | |||||||||
| 0006 | AUTO Fee | 0 | $0.00 | ||||||||||||
| 0007 | Cryo Pools - AB Surcharge | 0 | $0.00 | ||||||||||||
| 0008 | Cryo Poor Plasma | 0 | $0.00 | ||||||||||||
| 0009 | Cryoprecipitate (Single) | 0 | $0.00 | ||||||||||||
| 0010 | Cryoprecipitate Pools | 40 | 4 | 50 | 5 | 65 | 2 | 166 | $0.00 | ||||||
| 0011 | Deglyced Fee | 2 | 5 | 7 | $0.00 | ||||||||||
| 0012 | DIRD Fee | 1 | 1 | $0.00 | |||||||||||
| 0013 | Expedited Processing Fee (J8B) | 10 | 5 | 5 | 20 | $0.00 | |||||||||
| 0014 | FFP | 500 | 20 | 15 | 15 | 5 | 225 | 780 | $0.00 | ||||||
| 0015 | FFP Divided (Pedi Units) | 1 | 1 | $0.00 | |||||||||||
| 0016 | Frozen Fee | 0 | $0.00 | ||||||||||||
| 0017 | Irradiation Charge | 20 | 2 | 2 | 200 | 6 | 150 | 380 | $0.00 | ||||||
| 0018 | Leukoreduced Red Blood Cells (RBC) | 971 | 125 | 110 | 1,600 | 250 | 25 | 1,800 | 275 | 5156 | $0.00 | ||||
| 0019 | Liquid Plasma | 0 | $0.00 | ||||||||||||
| 0020 | O_N Red Blood Cell Surcharge | 120 | 55 | 30 | 205 | $0.00 | |||||||||
| 0021 | O_P Red Blood Cell Surcharge | 85 | 85 | $0.00 | |||||||||||
| 0022 | PAS Apheresis Platelets (SDP LVDS) | 75 | 5 | 80 | $0.00 | ||||||||||
| 0023 | Routine Delivery Fee | 48 | 48 | $0.00 | |||||||||||
| 0024 | Unscheduled Delivery (Y8B) | 60 | 24 | 50 | 134 | $0.00 | |||||||||
| 0025 | Washed Fee | 2 | 5 | 7 | $0.00 | ||||||||||
| 0026 | Whole Blood LR | 5 | 5 | $0.00 | |||||||||||
| 0027 | Autologous Packed Red Cells | 0 | $0.00 | ||||||||||||
| 0028 | HLA Matched Single Donor Platelets | 1 | 1 | $0.00 | |||||||||||
| 0029 | Single Donor Platelets (Leukofiltered) | 29 | 13 | 4 | 46 | $0.00 | |||||||||
| 0 | $0.00 | ||||||||||||||
| TOTAL | 1,750 | 164 | 131 | 2,678 | 526 | 258 | 2,240 | 549 | 8296 | ERROR:#VALUE! | |||||
| TABLE 2- LABORATORY SERVICES | |||||||||||||||
| CLIN | Category | Product Code | Product Description | FEE PER UNIT/SERVICE | Kansas City VAMC | Leavenworth VAMC | Topeka VAMC | Columbia VAMC | Marion VAMC | Poplar Bluff VAMC | St. Louis VAMC | Wichita VAMC | VISN 15 GRAND TOTAL WORKLOAD | VISN 15 GRAND TOTAL COSTS | |
| 0030 | HLA Product-Related | A7I | HLA select XMat PLT; HLA | 2 | 3 | 1 | 1 | 7 | $0.00 | ||||||
| 0031 | HLA Product-Related | B7I | PLT Ag neg/other comp HLA | 3 | 0 | 3 | $0.00 | ||||||||
| 0032 | HLA Product-Related | C7I | HLA Select PLT Cat1: HLA | 3 | 0 | 3 | $0.00 | ||||||||
| 0033 | HLA Product-Related | K7I | HPA-1a/PLA1 Neg PLT HLA | 3 | 0 | 3 | $0.00 | ||||||||
| 0034 | HLA Product-Related | L7I | PLT AgNeg/not HPA1aNegHLA | 2 | 0 | 2 | $0.00 | ||||||||
| 0035 | HLA STAT | D7I | HLA STAT Product, routine hours | 3 | 0 | 3 | $0.00 | ||||||||
| 0036 | HLA STAT | G7I | HLA STAT Product, non-routine hours | 2 | 1 | 3 | $0.00 | ||||||||
| 0037 | HLA STAT | 755 | HLA STAT Sample, Routine Hours | 3 | 0 | 3 | $0.00 | ||||||||
| 0038 | HLA STAT | 756 | HLA STAT Sample, Non-Routine Hours | 2 | 2 | 1 | 0 | 5 | $0.00 | ||||||
| 0039 | HLA Testing | H86022 | PLATELET CROSSMATCH, PER TEST | 3 | 0 | 3 | $0.00 | ||||||||
| 0040 | HLA Testing | H86023 | HLA; SINGLE ANTIGEN | 3 | 1 | 4 | $0.00 | ||||||||
| 0041 | HLA Testing | HLA008 | HLA; SINGLE ANTIGEN | 3 | 0 | 3 | $0.00 | ||||||||
| 0042 | HLA Testing | HLA009 | HLA; ANTIBODY SCREENING | 3 | 0 | 3 | $0.00 | ||||||||
| 0043 | HLA Testing | HLA012 | HLA; PLATELET ALLOIMMUN SCREEN | 1 | 0 | 1 | $0.00 | ||||||||
| 0044 | HLA Testing | HLA025 | HLA; ANTIBODY SCREEN FOR TRANSFUSION, CLASS I | 2 | 3 | 1 | 0 | 6 | $0.00 | ||||||
| 0045 | HLA Testing | HLA033 | HLA; MOLECULAR AB TYPING | 3 | 0 | 3 | $0.00 | ||||||||
| 0046 | HLA Testing | HLA04 | PLATELET ANTIBODY SCREEN | 2 | 2 | 1 | 0 | 5 | $0.00 | ||||||
| 0047 | HLA Testing | HLA064 | HLA;ANTIGEN TEST/PLATELET | 2 | 2 | 1 | 0 | 5 | $0.00 | ||||||
| 0048 | HLA Testing | HLA072 | HLA: A&B TYPING-FOR PLT TRANSFUSION | 1 | 0 | 1 | $0.00 | ||||||||
| 0049 | HLA Testing | HLA108 | HLA; ANTIBODY SCREEN FOR TRANSPORT, CLASS I AND II | 2 | 0 | 2 | $0.00 | ||||||||
| 0050 | HLA Testing | HLA109 | HLA; ANTIBODY IDENTIFICATION, CLASS I, IgG | 3 | 0 | 3 | $0.00 | ||||||||
| 0051 | HLA Testing | HLA123 | HLA-A (INTERMED RESOLUTION) | 2 | 0 | 2 | $0.00 | ||||||||
| 0052 | HLA Testing | HLA124 | HLA-B (INTERMED RESOLUTION) | 2 | 0 | 2 | $0.00 | ||||||||
| 0053 | HLA Testing | HLA157 | HLA: ANTIBODY ANALYSIS C1q, CLASS I | 3 | 0 | 3 | $0.00 | ||||||||
| 0054 | HLA Testing | HLA162 | Platelet HLA Type inquiry, per unit | 2 | 0 | 2 | $0.00 | ||||||||
| 0055 | HLA Testing | HLA164 | HLA select XM PLT, IRL | 0 | 0 | $0.00 | |||||||||
| 0056 | IRL Ag Neg | A4I | RBC Ag neg 1 per unit | 10 | 3 | 25 | 0 | 38 | $0.00 | ||||||
| 0057 | IRL Ag Neg | B4I | RBC Ag neg 2 per unit | 20 | 3 | 5 | 4 | 32 | $0.00 | ||||||
| 0058 | IRL Ag Neg | C4I | RBC Ag neg 3 per unit | 6 | 1 | 0 | 30 | 0 | 37 | $0.00 | |||||
| 0059 | IRL Ag Neg | D4I | RBC Ag neg 4 per unit | 1 | 0 | 1 | $0.00 | ||||||||
| 0060 | IRL Ag Neg | E4I | RBC Ag neg 5 per unit | 15 | 0 | 15 | $0.00 | ||||||||
| 0061 | IRL Ag Neg | E5I | Hist Ag inquiry/unit | 3 | 25 | 0 | 28 | $0.00 | |||||||
| 0062 | IRL Ag Neg | F4I | RBC Ag neg 6 per unit | 0 | 0 | $0.00 | |||||||||
| 0063 | IRL Ag Neg | G4I | RBC Ag neg 7 per unit | 0 | 0 | $0.00 | |||||||||
| 0064 | IRL Ag Neg | H4I | RBC Ag neg 8 per unit | 0 | 0 | $0.00 | |||||||||
| 0065 | IRL Ag Neg | I4I | RBC Ag neg 9 per unit | 0 | 0 | $0.00 | |||||||||
| 0066 | IRL Ag Neg | N5I | Hist Ag/Ag NT/each Ag | 3 | 0 | 3 | $0.00 | ||||||||
| 0067 | IRL Ag Neg | R5I | Hist Ag/Ag unconf/each Ag | 3 | 0 | 3 | $0.00 | ||||||||
| 0068 | IRL Ag Neg | R7I | RBC Ag neg 10 per unit | 0 | 0 | $0.00 | |||||||||
| 0069 | IRL Ag Neg | S5I | Allele selected/unit | 2 | 0 | 2 | $0.00 | ||||||||
| 0070 | IRL Ag Neg | T5I | Molecular type/each Ag | 0 | 0 | $0.00 | |||||||||
| 0071 | IRL Ag Neg | U5I | Special contract Ag/unit | 0 | 0 | $0.00 | |||||||||
| 0072 | IRL Ag Neg | U7I | RBC Ag neg 11 per unit | 0 | 0 | $0.00 | |||||||||
| 0073 | IRL Ag Neg | V7I | RBC Ag neg 12 per unit | 0 | 0 | $0.00 | |||||||||
| 0074 | IRL Ag Neg | W5I | RBC Ag neg 13 per unit | 0 | 0 | $0.00 | |||||||||
| 0075 | IRL Miscellaneous | REF71 | IRL Education Activity | 0 | 0 | $0.00 | |||||||||
| 0076 | IRL Platelet | D6I | Plt Ag neg not HPA-1a IRL | 0 | 0 | $0.00 | |||||||||
| 0077 | IRL Platelet | G6I | HLA antigen selected platelet-Category 1 | 1 | 0 | 1 | $0.00 | ||||||||
| 0078 | IRL Platelet | H6I | HLA antigen selected platelet-Category 2 | 1 | 0 | 1 | $0.00 | ||||||||
| 0079 | IRL Platelet | I5I | HPA-1a/PLA1 Neg PLT IRL | 0 | 0 | $0.00 | |||||||||
| 0080 | IRL Platelet | I6I | HLA antigen selected platelet-Category 3 | 1 | 0 | 1 | $0.00 | ||||||||
| 0081 | IRL Platelet | J5I | PLT Component, crossmatch | 2 | 0 | 0 | 2 | $0.00 | |||||||
| 0082 | IRL Platelet | L5I | PLT Ab per test, IRL | 2 | 2 | 0 | 0 | 4 | $0.00 | ||||||
| 0083 | IRL Platelet | PLT03 | Platelet ag typing (Serology), IRL | 0 | 0 | $0.00 | |||||||||
| 0084 | IRL Platelet | PLT04 | Platelet antibody, ELISA/Flow cytometry, IRL | 1 | 0 | 1 | $0.00 | ||||||||
| 0085 | IRL Platelet | PLT06 | Platelet Antibody ID, PSIFT, IRL | 1 | 0 | 1 | $0.00 | ||||||||
| 0086 | IRL Platelet | PLT08 | Platelet Antibody Drug Incubation, IRL | 1 | 0 | 1 | $0.00 | ||||||||
| 0087 | IRL Platelet | PLT09 | Heparin induced Plt Ab work-up, IRL | 2 | 0 | 0 | 2 | $0.00 | |||||||
| 0088 | IRL Platelet | PLT10 | Heparin induced Plt Ab Confirm, IRL | 0 | 0 | $0.00 | |||||||||
| 0089 | IRL Platelet | PLT11 | National Platelet Lab Referral Fee | 0 | 0 | $0.00 | |||||||||
| 0090 | IRL Platelet | SR86023 | Platelet Associated Ig (Direct) | 2 | 0 | 0 | 2 | $0.00 | |||||||
| 0091 | IRL Platelet | Z5I | HLA select XM PLT, IRL | 0 | 0 | $0.00 | |||||||||
| 0092 | IRL Product-Related | A5I | ARDP high rare Ag/unit | 0 | 0 | $0.00 | |||||||||
| 0093 | IRL Product-Related | A6I | PLT AgNeg/other comp IRL | 0 | 0 | $0.00 | |||||||||
| 0094 | IRL Product-Related | B5I | Historic HgbS per unit | 2 | 1 | 0 | 3 | $0.00 | |||||||
| 0095 | IRL Product-Related | B6I | Hemoglobin S, per test | 10 | 0 | 10 | $0.00 | ||||||||
| 0096 | IRL Product-Related | D5I | Unit search fee for RBC | 2 | 0 | 2 | $0.00 | ||||||||
| 0097 | IRL Product-Related | F5I | Rare/uncommon pheno/unit | 6 | 6 | $0.00 | |||||||||
| 0098 | IRL Product-Related | G5I | Ag type hosp segment/Ag | 0 | 0 | $0.00 | |||||||||
| 0099 | IRL Product-Related | H5I | Ag Screen-pt serum/unit | 3 | 0 | 3 | $0.00 | ||||||||
| 0100 | IRL Product-Related | J4I | Ag Scrn, spec order 1-10 | 3 | 0 | 3 | $0.00 | ||||||||
| 0101 | IRL Product-Related | K4I | Ag Scrn, spec order 11-20 | 0 | 0 | $0.00 | |||||||||
| 0102 | IRL Product-Related | L4I | Ag Scrn, spec order 21-30 | 0 | 0 | $0.00 | |||||||||
| 0103 | IRL Product-Related | M4I | Ag Scrn, spec order 31-40 | 0 | 0 | $0.00 | |||||||||
| 0104 | IRL Product-Related | N4I | Ag Scrn, spec order 41-50 | 0 | 0 | $0.00 | |||||||||
| 0105 | IRL Product-Related | O4I | Ag Scrn, spec order 51-60 | 0 | 0 | $0.00 | |||||||||
| 0106 | IRL Product-Related | P4I | Ag Scrn, spec order 61-70 | 0 | 0 | $0.00 | |||||||||
| 0107 | IRL Product-Related | Q4I | Special Recruitment Prod | 0 | 0 | $0.00 | |||||||||
| 0108 | IRL Product-Related | V5I | Regionally-defined fee | 0 | 0 | $0.00 | |||||||||
| 0109 | IRL Product-Related | X5I | IgA deficient component | 0 | 0 | $0.00 | |||||||||
| 0110 | IRL Specialty Testing | REF40 | IgA Testing | 0 | 0 | $0.00 | |||||||||
| 0111 | IRL Specialty Testing | REF41 | Expedited IgA testing | 0 | 0 | $0.00 | |||||||||
| 0112 | IRL Specialty Testing | REF44 | Monocyte Monolayer Assay | 0 | 0 | $0.00 | |||||||||
| 0113 | IRL Specialty Testing | REF45 | Special Antiglobulin Test | 0 | 0 | $0.00 | |||||||||
| 0114 | IRL Stat/Non-Routine | R4I | STAT Ag order routine hrs | 0 | 0 | $0.00 | |||||||||
| 0115 | IRL Stat/Non-Routine | REF33 | STAT IRL sample after hours | 2 | 2 | $0.00 | |||||||||
| 0116 | IRL Stat/Non-Routine | S4I | STAT Ag order non-rtn hrs | 3 | 2 | 5 | $0.00 | ||||||||
| 0117 | IRL Stat/Non-Routine | V4I | STAT IRL sample, routine hours | 2 | 2 | $0.00 | |||||||||
| 0118 | IRL Testing | 83033 | Hemoglobin F qualitative | 5 | 2 | 7 | $0.00 | ||||||||
| 0119 | IRL Testing | 85460 | Fetal Cell Quantitation – KB test | 0 | 0 | $0.00 | |||||||||
| 0120 | IRL Testing | 85461 | Hemoglobin – Fetal Rosette | 0 | 0 | $0.00 | |||||||||
| 0121 | IRL Testing | 86156 | Cold Agglutinin screen | 10 | 0 | 10 | $0.00 | ||||||||
| 0122 | IRL Testing | 86157 | Cold Agglutinin titer | 0 | 0 | $0.00 | |||||||||
| 0123 | IRL Testing | 86850 | Antibody Screen, each media | 28 | 1 | 24 | 5 | 5 | 0 | 63 | $0.00 | ||||
| 0124 | IRL Testing | 86860 | Antibody Screen, each media | 20 | 5 | 5 | 10 | 3 | 43 | $0.00 | |||||
| 0125 | IRL Testing | 86870 | Ab ID/each panel each media | 41 | 2 | 11 | 30 | 5 | 5 | 5 | 2 | 101 | $0.00 | ||
| 0126 | IRL Testing | 86880 | DAT, each antisera | 53 | 3 | 1 | 20 | 5 | 40 | 3 | 125 | $0.00 | |||
| 0127 | IRL Testing | 86885 | Ab ID, each selected reagent cell | 1 | 200 | 5 | 5 | 50 | 3 | 264 | $0.00 | ||||
| 0128 | IRL Testing | 86886 | Indirect titer, per Ab | 45 | 3 | 48 | $0.00 | ||||||||
| 0129 | IRL Testing | 86900 | ABO Type | 24 | 5 | 5 | 0 | 34 | $0.00 | ||||||
| 0130 | IRL Testing | 86901 | Rh(D)Type | 24 | 5 | 5 | 30 | 3 | 67 | $0.00 | |||||
| 0131 | IRL Testing | 86905 | RBC Ag, other than ABO or D, each | 200 | 2 | 5 | 30 | 3 | 240 | $0.00 | |||||
| 0132 | IRL Testing | 86906 | Rh Phenotyping, (C c E e) | 12 | 0 | 60 | 10 | 82 | $0.00 | ||||||
| 0133 | IRL Testing | 86940 | Hemolysins/agglutinins auto:each | 6 | 0 | 10 | 3 | 19 | $0.00 | ||||||
| 0134 | IRL Testing | 86941 | Hemolysins/agglutinins incubated | 6 | 0 | 0 | 6 | $0.00 | |||||||
| 0135 | IRL Testing | 86970 | Pre-Rx RBCs w/chemicals/drugs, per cell | 1 | 3 | 10 | 3 | 0 | 17 | $0.00 | |||||
| 0136 | IRL Testing | 86971 | Pre-treatment with enzymes, per cell | 4 | 300 | 3 | 1 | 15 | 0 | 323 | $0.00 | ||||
| 0137 | IRL Testing | 86972 | Separation by density gradient, retics | 10 | 1 | 11 | $0.00 | ||||||||
| 0138 | IRL Testing | 86975 | Incubation, serum and drugs, each | 3 | 0 | 3 | $0.00 | ||||||||
| 0139 | IRL Testing | 86976 | Dilution of serum, per aliquot | 0 | 0 | $0.00 | |||||||||
| 0140 | IRL Testing | 86977 | Incubation with inhibitors, per aliquot | 0 | 0 | $0.00 | |||||||||
| 0141 | IRL Testing | 86978 | Differential/Auto Ads, each adsorption | 12 | 1 | 0 | 13 | $0.00 | |||||||
| 0142 | IRL Testing | REF07 | Gel, red cell prep, each | 5 | 15 | 1 | 21 | $0.00 | |||||||
| 0143 | IRL Testing | REF08 | Basic Red Cell Antibody Identification | 1 | 25 | 0 | 26 | $0.00 | |||||||
| 0144 | IRL Testing | REF09 | Complex Red Cell Antibody Identification | 10 | 1 | 1 | 0 | 12 | $0.00 | ||||||
| 0145 | IRL Testing | REF11 | Solid Phase, red cell prep | 0 | 0 | $0.00 | |||||||||
| 0146 | IRL Testing | REF12 | Miscellaneous Adsorptions, per adsorp | 15 | 0 | 0 | 15 | $0.00 | |||||||
| 0147 | IRL Testing | REF13 | Complex prep of pt cells for adsorption | 0 | 0 | $0.00 | |||||||||
| 0148 | IRL Testing | REF14 | Thawing rare reagent red cells, per cell | 0 | 0 | $0.00 | |||||||||
| 0149 | IRL Testing | REF15 | Hypotonic Wash RBC separation | 0 | 0 | $0.00 | |||||||||
| 0150 | IRL Testing | REF16 | Concentration of fluids | 0 | 0 | $0.00 | |||||||||
| 0151 | IRL Testing | REF17 | Fetal Cell Quantitation, ELISA/Flow | 0 | 0 | $0.00 | |||||||||
| 0152 | IRL Testing | REF75 | Saline Replacement | 0 | 0 | $0.00 | |||||||||
| 0153 | IRL Transfusion Service | K5I | Transfusion Service tagging, PLT, IRL | 5 | 0 | 5 | $0.00 | ||||||||
| 0154 | IRL Transfusion Service | M5I | Immediate Spin crossmatch | 2 | 0 | 2 | $0.00 | ||||||||
| 0155 | IRL Transfusion Service | O5I | AGT phase of crossmatch | 3 | 0 | 3 | $0.00 | ||||||||
| 0156 | IRL Transfusion Service | Q5I | Frozen plasma thawing | 4 | 4 | $0.00 | |||||||||
| 0157 | Molecular Testing | SR81400A | 81105 HPA-1 Antigen Genotyping, SSP | 2 | 0 | 2 | $0.00 | ||||||||
| 0158 | Molecular Testing | SREF200A | 81403 ABO Genotyping, common alleles, SNP ID by RFLP | 9 | 2 | 0 | 11 | $0.00 | |||||||
| 0159 | Molecular Testing | SREF200B | 81403 RHD SNP detection by RFLP | 14 | 3 | 2 | 0 | 19 | $0.00 | ||||||
| 0160 | Molecular Testing | SREF200C | 81403 RHCE SNP by RFLP | 0 | 0 | $0.00 | |||||||||
| 0161 | Molecular Testing | SREF200D | 81403 RHD Zygosity PstI PCR RFLP | 0 | 0 | $0.00 | |||||||||
| 0162 | Molecular Testing | SREF250A | 81403 ABO common alleles, by SSP | 2 | 0 | 2 | $0.00 | ||||||||
| 0163 | Molecular Testing | SREF250B | 81403 RHD pseudogene & 455C by SSP | 0 | 0 | $0.00 | |||||||||
| 0164 | Molecular Testing | SREF250D | 81403 Multiplex PCR, partial RHD | 3 | 0 | 3 | $0.00 | ||||||||
| 0165 | Molecular Testing | SREF250E | 81403 RHD deletion detection, by SSP | 3 | 0 | 3 | $0.00 | ||||||||
| 0166 | Molecular Testing | SREF250H | Multiplex PCR, Big C, Little C, RHD Psi, exon 4 and 7 | 3 | 0 | 3 | $0.00 | ||||||||
| 0167 | Molecular Testing | SREF250J | 81403 Kidd genotyping, c.130 SSP | 3 | 0 | 3 | $0.00 | ||||||||
| 0168 | Molecular Testing | SREF32 | NML Sample, Urgent, routine hours | 0 | $0.00 | ||||||||||
| 0169 | Molecular Testing | SREF500B | 81403 Sanger Sequencing, 2-5 exons ART4 | 0 | 0 | $0.00 | |||||||||
| 0170 | Molecular Testing | SREF500C | 81403 Sanger Sequencing, 2-5 exons RHCE | 0 | 0 | $0.00 | |||||||||
| 0171 | Molecular Testing | SREF500D | 81403 Sanger Sequencing, 2-5 exons RHD | 0 | 0 | $0.00 | |||||||||
| 0172 | Molecular Testing | SREF500F | 81403 Sanger Sequencing, 2-5 exons ACKR1 | 0 | 0 | $0.00 | |||||||||
| 0173 | Molecular Testing | SREF500G | 81403 Sanger Sequencing, 2-5 exons glycophorin exons | 0 | 0 | $0.00 | |||||||||
| 0174 | Molecular Testing | SREF500J | 81403 Sanger Sequencing, 2-5 exons SLC14A1 | 0 | 0 | $0.00 | |||||||||
| 0175 | Molecular Testing | SREF500K | 81403 Sanger Sequencing, 2-5 exons KEL | 0 | 0 | $0.00 | |||||||||
| 0176 | Molecular Testing | SREF500L | 81403 Sanger Sequencing, 2-5 exons BCAM | 0 | 0 | $0.00 | |||||||||
| 0177 | Molecular Testing | SREF500N | 81403 Sanger Sequencing, 2-5 exons CR1 | 0 | 0 | $0.00 | |||||||||
| 0178 | Molecular Testing | SREF500R | 81403 Sanger Sequencing, 2-5 exons CROM | 0 | 0 | $0.00 | |||||||||
| 0179 | Molecular Testing | SREF500T | 81403 Sanger Sequencing, 2-5 exons KLF1 | 0 | 0 | $0.00 | |||||||||
| 0180 | Molecular Testing | SREF500X | 81403 Sanger Sequencing, 2-5 exons XK | 0 | 0 | $0.00 | |||||||||
| 0181 | Molecular Testing | SREF550A | 81403 Sanger Sequencing, 6-10 exons, ABO | 0 | 0 | $0.00 | |||||||||
| 0182 | Molecular Testing | SREF550C | 81403 Sanger Sequencing, 6-10 exons RHCE | 0 | 0 | $0.00 | |||||||||
| 0183 | Molecular Testing | SREF550D | 81403 Sanger Sequencing, 6-10 exons RHD | 0 | 0 | $0.00 | |||||||||
| 0184 | Molecular Testing | SREF550G | 81403 Sanger Sequencing, 6-10 exons glycophorin exons | 0 | 0 | $0.00 | |||||||||
| 0185 | Molecular Testing | SREF550J | 81403 Sanger Sequencing, 6-10 exons SLC14A1 | 0 | 0 | $0.00 | |||||||||
| 0186 | Molecular Testing | SREF550K | 81403 Sanger Sequencing, 6-10 exons KEL | 0 | 0 | $0.00 | |||||||||
| 0187 | Molecular Testing | SREF550L | 81403 Sanger Sequencing, 6-10 exons BCAM | 0 | 0 | $0.00 | |||||||||
| 0188 | Molecular Testing | SREF60 | 81479-Miscellaneous Molecular Testing | 0 | 0 | $0.00 | |||||||||
| 0189 | Molecular Testing | SREF600K | 81403 Sanger Sequencing, 11-25 exons, KEL | 0 | 0 | $0.00 | |||||||||
| 0190 | Molecular Testing | SREF600L | 81403 Sanger Sequencing, 11-25 exons, BCAM | 0 | 0 | $0.00 | |||||||||
| 0191 | Molecular Testing | SREF750C | 81403 cDNA analysis (high resolution), RHCE | 0 | 0 | $0.00 | |||||||||
| 0192 | Molecular Testing | SREF750D | 81403 cDNA analysis (high resolution), RHD | 0 | 0 | $0.00 | |||||||||
| 0193 | Molecular Testing | SREF750G | 81403 cDNA analysis (high resolution), glycophorins | 0 | 0 | $0.00 | |||||||||
| 0194 | Molecular Testing | SREF750J | 81403 cDNA analysis (high resolution), SLC14A1 | 0 | 0 | $0.00 | |||||||||
| 0195 | Molecular Testing | SREF750K | 81403 cDNA analysis (high resolution), KEL | 0 | 0 | $0.00 | |||||||||
| 0196 | Molecular Testing | SREF750L | 81403 cDNA analysis (high resolution), BCAM | 0 | 0 | $0.00 | |||||||||
| 0197 | Molecular Testing | SREFABRT | 81403 ABO genotyping | 0 | 0 | $0.00 | |||||||||
| 0198 | Molecular Testing | SREFFUT1 | 81403 Sanger Sequencing of FUT1 exon 4 | 0 | 0 | $0.00 | |||||||||
| 0199 | Molecular Testing | SREFFUT2 | 81403 Sanger Sequencing of FUT2 exon 2 | 0 | 0 | $0.00 | |||||||||
| 0200 | Molecular Testing | SREFHPRT | HPA Panel (replaces HP15, HPA2,3,4,5,6,9) | 0 | 0 | $0.00 | |||||||||
| 0201 | Molecular Testing | SREF-IVD | 0001U xHEA licensed RBC panel | 1 | 0 | 1 | $0.00 | ||||||||
| 0202 | Molecular Testing | SREF-RHB | 81403x2 Full RH genotyping (replaces SREF-RHD & SREF-450) | 4 | 2 | 1 | 0 | 7 | $0.00 | ||||||
| 0203 | Molecular Testing | SREF-RHZ | 81403 RHD Hybrid Rhesus Box detection | 0 | 0 | $0.00 | |||||||||
| 0204 | Molecular Testing | SREFSEQB | 81403 Sanger Sequencing, 1 exon ART4 | 0 | 0 | $0.00 | |||||||||
| 0205 | Molecular Testing | SREFSEQC | 81403 Sanger Sequencing, 1 exon RHCE | 0 | 0 | $0.00 | |||||||||
| 0206 | Molecular Testing | SREFSEQD | 81403 Sanger Sequencing, 1 exon RHD | 0 | 0 | $0.00 | |||||||||
| 0207 | Molecular Testing | SREFSEQF | 81403 Sanger Sequencing, 1 exon ACKR1 | 0 | 0 | $0.00 | |||||||||
| 0208 | Molecular Testing | SREFSEQJ | 81403 Sanger Sequencing, 1 exon SLC14A1 | 0 | 0 | $0.00 | |||||||||
| 0209 | Molecular Testing | SREFSEQK | 81403 Sanger Sequencing, 1 exon KEL | 0 | 0 | $0.00 | |||||||||
| 0210 | Molecular Testing | SREFSEQL | 81403 Sanger Sequencing, 1 exon BCAM | 0 | 0 | $0.00 | |||||||||
| 0211 | Molecular Testing | SREFSEQT | 81403 Sanger Sequencing, 1 exon KLF1 | 0 | 0 | $0.00 | |||||||||
| 0212 | Molecular Testing | SREFSEQX | 81403 Sanger Sequencing, 1 exon XK | 0 | 0 | $0.00 | |||||||||
| 0213 | Molecular Testing | SREFSEQY | 81403 Sanger Sequencing, 1 exon ACHE | 0 | 0 | $0.00 | |||||||||
| 0214 | Molecular Testing | SREFSQGA | 81403 Sanger Sequencing, 1 exon glycophorin GYPA | 0 | 0 | $0.00 | |||||||||
| 0215 | Molecular Testing | SREFSQGB | 81403 Sanger Sequencing, 1 exon glycophorin GYPB | 0 | 0 | $0.00 | |||||||||
| 0216 | Neutrophil | 86021 | Neutrophil Antibody Identification | 0 | 0 | $0.00 | |||||||||
| 0217 | Neutrophil | 88102 | Neutrophil Crossmatch | 0 | 0 | $0.00 | |||||||||
| 0218 | Neutrophil | N86022 | Platelet crossmatch, NEU | 0 | 0 | $0.00 | |||||||||
| 0219 | Neutrophil | NEU01 | Neutrophil Ag typing, Serology, NEU | 0 | 0 | $0.00 | |||||||||
| 0220 | Neutrophil | NEU03 | HPA-1a antigen phenotyping | 0 | 0 | $0.00 | |||||||||
| 0221 | Neutrophil | NEU04 | Platelet antibody screen, ELISA | 0 | 0 | $0.00 | |||||||||
| 0222 | Neutrophil | NEU05 | Drug Dependent Neutrophil Antibody | 0 | 0 | $0.00 | |||||||||
| 0223 | Neutrophil | NEU06 | Extended Ab ID (MAINA) | 0 | 0 | $0.00 | |||||||||
| 0224 | Neutrophil | NEU08 | Platelet Antibody Identification | 0 | 0 | $0.00 | |||||||||
| 0225 | Neutrophil | NEU11 | National Neutrophil Lab Referral fee | 0 | 0 | $0.00 | |||||||||
| 0226 | Neutrophil | NNEUT1 | 81479 HNA-1a/1b/1c | 0 | 0 | $0.00 | |||||||||
| 0227 | Neutrophil | NNEUT3 | 81479 HNA-3a/3b | 0 | 0 | $0.00 | |||||||||
| 0228 | Neutrophil | NNEUT4 | 81479 HNA-4a/4bw | 0 | 0 | $0.00 | |||||||||
| 0229 | Neutrophil | NNEUT5 | 81479 HNA-5a/5bw | 0 | 0 | $0.00 | |||||||||
| 0230 | Neutrophil | NNEUT99 | 81479 HNA Panel (HNA-1, 3, 4, 5) | 0 | 0 | $0.00 | |||||||||
| 0231 | Neutrophil | XMPLT | Platelet Crossmatch Incompatibility Screen | 0 | 0 | $0.00 | |||||||||
| 0232 | Product Related | C6I | Anti-CMV negative, per test | 2 | 2 | 2 | 0 | 6 | $0.00 | ||||||
| 0233 | Product Related | M1M | Unit W/1 Empty Bag - EMP1 | 0 | 0 | $0.00 | |||||||||
| 0234 | Product Related | N1M | Unit W/2 Empty Bag - EMP2 | 0 | 0 | $0.00 | |||||||||
| 0235 | Product Related | O1M | Unit W/3 Empty Bag - EMP3 | 0 | 0 | $0.00 | |||||||||
| 0236 | Product Related | P1M | Unit W/4 Empty Bag - EMP4 | 0 | 0 | $0.00 | |||||||||
| 0237 | Product Related | Q1M | Unit Less than 14 Days | 0 | 0 | $0.00 | |||||||||
| 0238 | Product Related | T1M | Unit Less than 48 Hours | 0 | 0 | $0.00 | |||||||||
| 0239 | Product Related | U1M | Unit Less than 5 Days | 0 | 0 | $0.00 | |||||||||
| 0240 | Product Related | V1M | Unit Less than 6 Days | 0 | 0 | $0.00 | |||||||||
| 0241 | Product Related | Y3M | Pedi Unit | 0 | 0 | $0.00 | |||||||||
| 0242 | Therapeutics | THAP100 | THAP: PLASMAPHERESIS | 80 | 200 | 0 | 0 | 280 | $0.00 | ||||||
| 0243 | Therapeutics | THAP110 | THAP: PHOTOPHERESIS CANCELLATION FEE - AFTER SET-UP | 2 | 0 | 0 | 2 | $0.00 | |||||||
| 0244 | Therapeutics | THAP112 | THAP: AFTER-HOURS / WEEKEND / HOLIDAY FEE | 10 | 12 | 0 | 0 | 22 | $0.00 | ||||||
| 0245 | Therapeutics | THAP114 | THAP: ADDITIONAL HOURS FEE | 0 | 0 | $0.00 | |||||||||
| 0246 | Therapeutics | THAP116 | THAP: STAT / RUSH FEE | 0 | 0 | $0.00 | |||||||||
| 0247 | Therapeutics | THAP117 | THAP: ARC PERSONNEL TIME - REQUIRED ORIENTATION - PER 15 MINUTES | 0 | 0 | $0.00 | |||||||||
| 0248 | Therapeutics | THAP119 | THAP: CVC DRESSING CHANGE | 0 | 0 | $0.00 | |||||||||
| 0249 | Therapeutics | THAP126 | THAP: THERAPEUTIC PHLEBOTOMY | 0 | 0 | $0.00 | |||||||||
| 0250 | Therapeutics | THAP129 | THAP: THROMBOCYTAPHERESIS | 0 | 0 | $0.00 | |||||||||
| 0251 | Therapeutics | THAP130 | THAP: ERYTHROCYTAPHERESIS | 0 | 0 | $0.00 | |||||||||
| 0252 | Therapeutics | THAP133 | THAP: LEUKOCYTAPHERESIS | 0 | 0 | $0.00 | |||||||||
| 0253 | Therapeutics | THAP150 | THAP: CANCELLATION FEE - BEFORE SETUP | 0 | 0 | $0.00 | |||||||||
| 0254 | Therapeutics | THAP151 | THAP: CANCELLATION FEE - AFTER SET-UP | 0 | 0 | $0.00 | |||||||||
| 0255 | Therapeutics | THAP170 | THAP: STAND-BY FEE - PER 15 MINUTES | 0 | 0 | $0.00 | |||||||||
| 0256 | TRANSPORTATION | TRANSPORTATION OF SPECIMENS AND/OR DONOR UNITS | 0 | $0.00 | |||||||||||
| 0257 | Albumin 250 ml | 750 | 750 | $0.00 | |||||||||||
| 0258 | Ag Neg Low Incidence | 0 | $0.00 | ||||||||||||
| 0259 | Ag Neg Unit <1% Freq | 21 | 21 | $0.00 | |||||||||||
| 0260 | Ag Neg Unit 1% Freq | 5 | 5 | $0.00 | |||||||||||
| 0261 | Ag Neg Unit 2% Freq | 5 | 3 | 5 | 13 | $0.00 | |||||||||
| 0262 | Ag Neg Unit 4-6% Frq | 1 | 1 | 5 | 7 | $0.00 | |||||||||
| 0263 | Ag Neg Unit 7% Freq | 5 | 5 | $0.00 | |||||||||||
| 0264 | Ag Type Major Ag | 9 | 9 | $0.00 | |||||||||||
| 0265 | CMP Scr Neat Ag Neg | 1 | 1 | 2 | $0.00 | ||||||||||
| 0266 | Covid-19 Convalescent Plasma | 2 | 2 | $0.00 | |||||||||||
| 0267 | Elution Preparation | 13 | 13 | $0.00 | |||||||||||
| 0268 | HEA Panel Reflex | 2 | 2 | $0.00 | |||||||||||
| 0269 | Inhibition of Plasma | 1 | 1 | $0.00 | |||||||||||
| 0270 | Pre-Warm/Warm Wash | 8 | 10 | 18 | $0.00 | ||||||||||
| 0271 | RBC, CPDA-1,Lr | 5 | 5 | $0.00 | |||||||||||
| 0272 | RBC, CPDA-1,Lr,Irr | 4 | 4 | $0.00 | |||||||||||
| 0273 | Screen Gel | 7 | 7 | $0.00 | |||||||||||
| 0274 | Screen Rare | 1 | 1 | 2 | $0.00 | ||||||||||
| 0275 | Screen Tube | 20 | 20 | $0.00 | |||||||||||
| 0276 | Thermal Amplitude | 0 | $0.00 | ||||||||||||
| TOTAL | 1126 | 17 | 50 | 1175 | 170 | 79 | 428 | 60 | 3105 | $0.00 |
Ordering Year 2
| Ordering Year 2 4/1/2023 - 3/31/2024 | VISN 15 Blood Bank Products | ||||||||||||||
| TABLE 1 - BLOOD PRODUCTS | |||||||||||||||
| Line Items | BLOOD PRODUCTS, SERVICES, AND DELIVERY | FEE PER UNIT/SERVICE | Estimated Workload | ||||||||||||
| Kansas City VAMC | Estimated Workload Leavenworth VAMC | Estimated Workload Topeka VAMC | Estimated Workload Columbia VAMC | Estimated Workload Marion VAMC | Poplar Bluff VAMC | Estimated Workload St. Louis VAMC | Estimated Workload Wichita VAMC | VISN 15 GRAND TOTAL WORKLOAD | VISN 15 GRAND TOTAL COSTS | ||||||
| 0001 | 24 Hour Plasma | $0.00 | 350 | 7 | 15 | 372 | $0.00 | ||||||||
| 0002 | AB Cryo Surcharge | 175 | 175 | $0.00 | |||||||||||
| 0003 | AB Plasma Surcharge | 12 | 4 | 1 | 2 | 19 | $0.00 | ||||||||
| 0004 | Apheresis Platelets - Pathogen Reduced (SDP-PR) | 99 | 260 | 22 | 25 | 75 | 20 | 501 | $0.00 | ||||||
| 0005 | Apheresis Platelets (SDP LVDS) | 90 | 12 | 5 | 107 | $0.00 | |||||||||
| 0006 | AUTO Fee | 0 | $0.00 | ||||||||||||
| 0007 | Cryo Pools - AB Surcharge | 0 | $0.00 | ||||||||||||
| 0008 | Cryo Poor Plasma | 0 | $0.00 | ||||||||||||
| 0009 | Cryoprecipitate (Single) | 0 | $0.00 | ||||||||||||
| 0010 | Cryoprecipitate Pools | 40 | 4 | 50 | 5 | 65 | 2 | 166 | $0.00 | ||||||
| 0011 | Deglyced Fee | 2 | 5 | 7 | $0.00 | ||||||||||
| 0012 | DIRD Fee | 1 | 1 | $0.00 | |||||||||||
| 0013 | Expedited Processing Fee (J8B) | 10 | 5 | 5 | 20 | $0.00 | |||||||||
| 0014 | FFP | 500 | 20 | 15 | 15 | 5 | 225 | 780 | $0.00 | ||||||
| 0015 | FFP Divided (Pedi Units) | 1 | 1 | $0.00 | |||||||||||
| 0016 | Frozen Fee | 0 | $0.00 | ||||||||||||
| 0017 | Irradiation Charge | 20 | 2 | 2 | 200 | 6 | 150 | 380 | $0.00 | ||||||
| 0018 | Leukoreduced Red Blood Cells (RBC) | 971 | 125 | 110 | 1,600 | 250 | 25 | 1,800 | 275 | 5156 | $0.00 | ||||
| 0019 | Liquid Plasma | 0 | $0.00 | ||||||||||||
| 0020 | O_N Red Blood Cell Surcharge | 120 | 55 | 30 | 205 | $0.00 | |||||||||
| 0021 | O_P Red Blood Cell Surcharge | 85 | 85 | $0.00 | |||||||||||
| 0022 | PAS Apheresis Platelets (SDP LVDS) | 75 | 5 | 80 | $0.00 | ||||||||||
| 0023 | Routine Delivery Fee | 48 | 48 | $0.00 | |||||||||||
| 0024 | Unscheduled Delivery (Y8B) | 60 | 24 | 50 | 134 | $0.00 | |||||||||
| 0025 | Washed Fee | 2 | 5 | 7 | $0.00 | ||||||||||
| 0026 | Whole Blood LR | 5 | 5 | $0.00 | |||||||||||
| 0027 | Autologous Packed Red Cells | 0 | $0.00 | ||||||||||||
| 0028 | HLA Matched Single Donor Platelets | 1 | 1 | $0.00 | |||||||||||
| 0029 | Single Donor Platelets (Leukofiltered) | 29 | 13 | 4 | 46 | $0.00 | |||||||||
| 0 | $0.00 | ||||||||||||||
| TOTAL | 1,750 | 164 | 131 | 2,678 | 526 | 258 | 2,240 | 549 | 8296 | ERROR:#VALUE! | |||||
| TABLE 2- LABORATORY SERVICES | |||||||||||||||
| CLIN | Category | Product Code | Product Description | FEE PER UNIT/SERVICE | Kansas City VAMC | Leavenworth VAMC | Topeka VAMC | Columbia VAMC | Marion VAMC | Poplar Bluff VAMC | St. Louis VAMC | Wichita VAMC | VISN 15 GRAND TOTAL WORKLOAD | VISN 15 GRAND TOTAL COSTS | |
| 0030 | HLA Product-Related | A7I | HLA select XMat PLT; HLA | 2 | 3 | 1 | 1 | 7 | $0.00 | ||||||
| 0031 | HLA Product-Related | B7I | PLT Ag neg/other comp HLA | 3 | 0 | 3 | $0.00 | ||||||||
| 0032 | HLA Product-Related | C7I | HLA Select PLT Cat1: HLA | 3 | 0 | 3 | $0.00 | ||||||||
| 0033 | HLA Product-Related | K7I | HPA-1a/PLA1 Neg PLT HLA | 3 | 0 | 3 | $0.00 | ||||||||
| 0034 | HLA Product-Related | L7I | PLT AgNeg/not HPA1aNegHLA | 2 | 0 | 2 | $0.00 | ||||||||
| 0035 | HLA STAT | D7I | HLA STAT Product, routine hours | 3 | 0 | 3 | $0.00 | ||||||||
| 0036 | HLA STAT | G7I | HLA STAT Product, non-routine hours | 2 | 1 | 3 | $0.00 | ||||||||
| 0037 | HLA STAT | 755 | HLA STAT Sample, Routine Hours | 3 | 0 | 3 | $0.00 | ||||||||
| 0038 | HLA STAT | 756 | HLA STAT Sample, Non-Routine Hours | 2 | 2 | 1 | 0 | 5 | $0.00 | ||||||
| 0039 | HLA Testing | H86022 | PLATELET CROSSMATCH, PER TEST | 3 | 0 | 3 | $0.00 | ||||||||
| 0040 | HLA Testing | H86023 | HLA; SINGLE ANTIGEN | 3 | 1 | 4 | $0.00 | ||||||||
| 0041 | HLA Testing | HLA008 | HLA; SINGLE ANTIGEN | 3 | 0 | 3 | $0.00 | ||||||||
| 0042 | HLA Testing | HLA009 | HLA; ANTIBODY SCREENING | 3 | 0 | 3 | $0.00 | ||||||||
| 0043 | HLA Testing | HLA012 | HLA; PLATELET ALLOIMMUN SCREEN | 1 | 0 | 1 | $0.00 | ||||||||
| 0044 | HLA Testing | HLA025 | HLA; ANTIBODY SCREEN FOR TRANSFUSION, CLASS I | 2 | 3 | 1 | 0 | 6 | $0.00 | ||||||
| 0045 | HLA Testing | HLA033 | HLA; MOLECULAR AB TYPING | 3 | 0 | 3 | $0.00 | ||||||||
| 0046 | HLA Testing | HLA04 | PLATELET ANTIBODY SCREEN | 2 | 2 | 1 | 0 | 5 | $0.00 | ||||||
| 0047 | HLA Testing | HLA064 | HLA;ANTIGEN TEST/PLATELET | 2 | 2 | 1 | 0 | 5 | $0.00 | ||||||
| 0048 | HLA Testing | HLA072 | HLA: A&B TYPING-FOR PLT TRANSFUSION | 1 | 0 | 1 | $0.00 | ||||||||
| 0049 | HLA Testing | HLA108 | HLA; ANTIBODY SCREEN FOR TRANSPORT, CLASS I AND II | 2 | 0 | 2 | $0.00 | ||||||||
| 0050 | HLA Testing | HLA109 | HLA; ANTIBODY IDENTIFICATION, CLASS I, IgG | 3 | 0 | 3 | $0.00 | ||||||||
| 0051 | HLA Testing | HLA123 | HLA-A (INTERMED RESOLUTION) | 2 | 0 | 2 | $0.00 | ||||||||
| 0052 | HLA Testing | HLA124 | HLA-B (INTERMED RESOLUTION) | 2 | 0 | 2 | $0.00 | ||||||||
| 0053 | HLA Testing | HLA157 | HLA: ANTIBODY ANALYSIS C1q, CLASS I | 3 | 0 | 3 | $0.00 | ||||||||
| 0054 | HLA Testing | HLA162 | Platelet HLA Type inquiry, per unit | 2 | 0 | 2 | $0.00 | ||||||||
| 0055 | HLA Testing | HLA164 | HLA select XM PLT, IRL | 0 | 0 | $0.00 | |||||||||
| 0056 | IRL Ag Neg | A4I | RBC Ag neg 1 per unit | 10 | 3 | 25 | 0 | 38 | $0.00 | ||||||
| 0057 | IRL Ag Neg | B4I | RBC Ag neg 2 per unit | 20 | 3 | 5 | 4 | 32 | $0.00 | ||||||
| 0058 | IRL Ag Neg | C4I | RBC Ag neg 3 per unit | 6 | 1 | 0 | 30 | 0 | 37 | $0.00 | |||||
| 0059 | IRL Ag Neg | D4I | RBC Ag neg 4 per unit | 1 | 0 | 1 | $0.00 | ||||||||
| 0060 | IRL Ag Neg | E4I | RBC Ag neg 5 per unit | 15 | 0 | 15 | $0.00 | ||||||||
| 0061 | IRL Ag Neg | E5I | Hist Ag inquiry/unit | 3 | 25 | 0 | 28 | $0.00 | |||||||
| 0062 | IRL Ag Neg | F4I | RBC Ag neg 6 per unit | 0 | 0 | $0.00 | |||||||||
| 0063 | IRL Ag Neg | G4I | RBC Ag neg 7 per unit | 0 | 0 | $0.00 | |||||||||
| 0064 | IRL Ag Neg | H4I | RBC Ag neg 8 per unit | 0 | 0 | $0.00 | |||||||||
| 0065 | IRL Ag Neg | I4I | RBC Ag neg 9 per unit | 0 | 0 | $0.00 | |||||||||
| 0066 | IRL Ag Neg | N5I | Hist Ag/Ag NT/each Ag | 3 | 0 | 3 | $0.00 | ||||||||
| 0067 | IRL Ag Neg | R5I | Hist Ag/Ag unconf/each Ag | 3 | 0 | 3 | $0.00 | ||||||||
| 0068 | IRL Ag Neg | R7I | RBC Ag neg 10 per unit | 0 | 0 | $0.00 | |||||||||
| 0069 | IRL Ag Neg | S5I | Allele selected/unit | 2 | 0 | 2 | $0.00 | ||||||||
| 0070 | IRL Ag Neg | T5I | Molecular type/each Ag | 0 | 0 | $0.00 | |||||||||
| 0071 | IRL Ag Neg | U5I | Special contract Ag/unit | 0 | 0 | $0.00 | |||||||||
| 0072 | IRL Ag Neg | U7I | RBC Ag neg 11 per unit | 0 | 0 | $0.00 | |||||||||
| 0073 | IRL Ag Neg | V7I | RBC Ag neg 12 per unit | 0 | 0 | $0.00 | |||||||||
| 0074 | IRL Ag Neg | W5I | RBC Ag neg 13 per unit | 0 | 0 | $0.00 | |||||||||
| 0075 | IRL Miscellaneous | REF71 | IRL Education Activity | 0 | 0 | $0.00 | |||||||||
| 0076 | IRL Platelet | D6I | Plt Ag neg not HPA-1a IRL | 0 | 0 | $0.00 | |||||||||
| 0077 | IRL Platelet | G6I | HLA antigen selected platelet-Category 1 | 1 | 0 | 1 | $0.00 | ||||||||
| 0078 | IRL Platelet | H6I | HLA antigen selected platelet-Category 2 | 1 | 0 | 1 | $0.00 | ||||||||
| 0079 | IRL Platelet | I5I | HPA-1a/PLA1 Neg PLT IRL | 0 | 0 | $0.00 | |||||||||
| 0080 | IRL Platelet | I6I | HLA antigen selected platelet-Category 3 | 1 | 0 | 1 | $0.00 | ||||||||
| 0081 | IRL Platelet | J5I | PLT Component, crossmatch | 2 | 0 | 0 | 2 | $0.00 | |||||||
| 0082 | IRL Platelet | L5I | PLT Ab per test, IRL | 2 | 2 | 0 | 0 | 4 | $0.00 | ||||||
| 0083 | IRL Platelet | PLT03 | Platelet ag typing (Serology), IRL | 0 | 0 | $0.00 | |||||||||
| 0084 | IRL Platelet | PLT04 | Platelet antibody, ELISA/Flow cytometry, IRL | 1 | 0 | 1 | $0.00 | ||||||||
| 0085 | IRL Platelet | PLT06 | Platelet Antibody ID, PSIFT, IRL | 1 | 0 | 1 | $0.00 | ||||||||
| 0086 | IRL Platelet | PLT08 | Platelet Antibody Drug Incubation, IRL | 1 | 0 | 1 | $0.00 | ||||||||
| 0087 | IRL Platelet | PLT09 | Heparin induced Plt Ab work-up, IRL | 2 | 0 | 0 | 2 | $0.00 | |||||||
| 0088 | IRL Platelet | PLT10 | Heparin induced Plt Ab Confirm, IRL | 0 | 0 | $0.00 | |||||||||
| 0089 | IRL Platelet | PLT11 | National Platelet Lab Referral Fee | 0 | 0 | $0.00 | |||||||||
| 0090 | IRL Platelet | SR86023 | Platelet Associated Ig (Direct) | 2 | 0 | 0 | 2 | $0.00 | |||||||
| 0091 | IRL Platelet | Z5I | HLA select XM PLT, IRL | 0 | 0 | $0.00 | |||||||||
| 0092 | IRL Product-Related | A5I | ARDP high rare Ag/unit | 0 | 0 | $0.00 | |||||||||
| 0093 | IRL Product-Related | A6I | PLT AgNeg/other comp IRL | 0 | 0 | $0.00 | |||||||||
| 0094 | IRL Product-Related | B5I | Historic HgbS per unit | 2 | 1 | 0 | 3 | $0.00 | |||||||
| 0095 | IRL Product-Related | B6I | Hemoglobin S, per test | 10 | 0 | 10 | $0.00 | ||||||||
| 0096 | IRL Product-Related | D5I | Unit search fee for RBC | 2 | 0 | 2 | $0.00 | ||||||||
| 0097 | IRL Product-Related | F5I | Rare/uncommon pheno/unit | 6 | 6 | $0.00 | |||||||||
| 0098 | IRL Product-Related | G5I | Ag type hosp segment/Ag | 0 | 0 | $0.00 | |||||||||
| 0099 | IRL Product-Related | H5I | Ag Screen-pt serum/unit | 3 | 0 | 3 | $0.00 | ||||||||
| 0100 | IRL Product-Related | J4I | Ag Scrn, spec order 1-10 | 3 | 0 | 3 | $0.00 | ||||||||
| 0101 | IRL Product-Related | K4I | Ag Scrn, spec order 11-20 | 0 | 0 | $0.00 | |||||||||
| 0102 | IRL Product-Related | L4I | Ag Scrn, spec order 21-30 | 0 | 0 | $0.00 | |||||||||
| 0103 | IRL Product-Related | M4I | Ag Scrn, spec order 31-40 | 0 | 0 | $0.00 | |||||||||
| 0104 | IRL Product-Related | N4I | Ag Scrn, spec order 41-50 | 0 | 0 | $0.00 | |||||||||
| 0105 | IRL Product-Related | O4I | Ag Scrn, spec order 51-60 | 0 | 0 | $0.00 | |||||||||
| 0106 | IRL Product-Related | P4I | Ag Scrn, spec order 61-70 | 0 | 0 | $0.00 | |||||||||
| 0107 | IRL Product-Related | Q4I | Special Recruitment Prod | 0 | 0 | $0.00 | |||||||||
| 0108 | IRL Product-Related | V5I | Regionally-defined fee | 0 | 0 | $0.00 | |||||||||
| 0109 | IRL Product-Related | X5I | IgA deficient component | 0 | 0 | $0.00 | |||||||||
| 0110 | IRL Specialty Testing | REF40 | IgA Testing | 0 | 0 | $0.00 | |||||||||
| 0111 | IRL Specialty Testing | REF41 | Expedited IgA testing | 0 | 0 | $0.00 | |||||||||
| 0112 | IRL Specialty Testing | REF44 | Monocyte Monolayer Assay | 0 | 0 | $0.00 | |||||||||
| 0113 | IRL Specialty Testing | REF45 | Special Antiglobulin Test | 0 | 0 | $0.00 | |||||||||
| 0114 | IRL Stat/Non-Routine | R4I | STAT Ag order routine hrs | 0 | 0 | $0.00 | |||||||||
| 0115 | IRL Stat/Non-Routine | REF33 | STAT IRL sample after hours | 2 | 2 | $0.00 | |||||||||
| 0116 | IRL Stat/Non-Routine | S4I | STAT Ag order non-rtn hrs | 3 | 2 | 5 | $0.00 | ||||||||
| 0117 | IRL Stat/Non-Routine | V4I | STAT IRL sample, routine hours | 2 | 2 | $0.00 | |||||||||
| 0118 | IRL Testing | 83033 | Hemoglobin F qualitative | 5 | 2 | 7 | $0.00 | ||||||||
| 0119 | IRL Testing | 85460 | Fetal Cell Quantitation – KB test | 0 | 0 | $0.00 | |||||||||
| 0120 | IRL Testing | 85461 | Hemoglobin – Fetal Rosette | 0 | 0 | $0.00 | |||||||||
| 0121 | IRL Testing | 86156 | Cold Agglutinin screen | 10 | 0 | 10 | $0.00 | ||||||||
| 0122 | IRL Testing | 86157 | Cold Agglutinin titer | 0 | 0 | $0.00 | |||||||||
| 0123 | IRL Testing | 86850 | Antibody Screen, each media | 28 | 1 | 24 | 5 | 5 | 0 | 63 | $0.00 | ||||
| 0124 | IRL Testing | 86860 | Antibody Screen, each media | 20 | 5 | 5 | 10 | 3 | 43 | $0.00 | |||||
| 0125 | IRL Testing | 86870 | Ab ID/each panel each media | 41 | 2 | 11 | 30 | 5 | 5 | 5 | 2 | 101 | $0.00 | ||
| 0126 | IRL Testing | 86880 | DAT, each antisera | 53 | 3 | 1 | 20 | 5 | 40 | 3 | 125 | $0.00 | |||
| 0127 | IRL Testing | 86885 | Ab ID, each selected reagent cell | 1 | 200 | 5 | 5 | 50 | 3 | 264 | $0.00 | ||||
| 0128 | IRL Testing | 86886 | Indirect titer, per Ab | 45 | 3 | 48 | $0.00 | ||||||||
| 0129 | IRL Testing | 86900 | ABO Type | 24 | 5 | 5 | 0 | 34 | $0.00 | ||||||
| 0130 | IRL Testing | 86901 | Rh(D)Type | 24 | 5 | 5 | 30 | 3 | 67 | $0.00 | |||||
| 0131 | IRL Testing | 86905 | RBC Ag, other than ABO or D, each | 200 | 2 | 5 | 30 | 3 | 240 | $0.00 | |||||
| 0132 | IRL Testing | 86906 | Rh Phenotyping, (C c E e) | 12 | 0 | 60 | 10 | 82 | $0.00 | ||||||
| 0133 | IRL Testing | 86940 | Hemolysins/agglutinins auto:each | 6 | 0 | 10 | 3 | 19 | $0.00 | ||||||
| 0134 | IRL Testing | 86941 | Hemolysins/agglutinins incubated | 6 | 0 | 0 | 6 | $0.00 | |||||||
| 0135 | IRL Testing | 86970 | Pre-Rx RBCs w/chemicals/drugs, per cell | 1 | 3 | 10 | 3 | 0 | 17 | $0.00 | |||||
| 0136 | IRL Testing | 86971 | Pre-treatment with enzymes, per cell | 4 | 300 | 3 | 1 | 15 | 0 | 323 | $0.00 | ||||
| 0137 | IRL Testing | 86972 | Separation by density gradient, retics | 10 | 1 | 11 | $0.00 | ||||||||
| 0138 | IRL Testing | 86975 | Incubation, serum and drugs, each | 3 | 0 | 3 | $0.00 | ||||||||
| 0139 | IRL Testing | 86976 | Dilution of serum, per aliquot | 0 | 0 | $0.00 | |||||||||
| 0140 | IRL Testing | 86977 | Incubation with inhibitors, per aliquot | 0 | 0 | $0.00 | |||||||||
| 0141 | IRL Testing | 86978 | Differential/Auto Ads, each adsorption | 12 | 1 | 0 | 13 | $0.00 | |||||||
| 0142 | IRL Testing | REF07 | Gel, red cell prep, each | 5 | 15 | 1 | 21 | $0.00 | |||||||
| 0143 | IRL Testing | REF08 | Basic Red Cell Antibody Identification | 1 | 25 | 0 | 26 | $0.00 | |||||||
| 0144 | IRL Testing | REF09 | Complex Red Cell Antibody Identification | 10 | 1 | 1 | 0 | 12 | $0.00 | ||||||
| 0145 | IRL Testing | REF11 | Solid Phase, red cell prep | 0 | 0 | $0.00 | |||||||||
| 0146 | IRL Testing | REF12 | Miscellaneous Adsorptions, per adsorp | 15 | 0 | 0 | 15 | $0.00 | |||||||
| 0147 | IRL Testing | REF13 | Complex prep of pt cells for adsorption | 0 | 0 | $0.00 | |||||||||
| 0148 | IRL Testing | REF14 | Thawing rare reagent red cells, per cell | 0 | 0 | $0.00 | |||||||||
| 0149 | IRL Testing | REF15 | Hypotonic Wash RBC separation | 0 | 0 | $0.00 | |||||||||
| 0150 | IRL Testing | REF16 | Concentration of fluids | 0 | 0 | $0.00 | |||||||||
| 0151 | IRL Testing | REF17 | Fetal Cell Quantitation, ELISA/Flow | 0 | 0 | $0.00 | |||||||||
| 0152 | IRL Testing | REF75 | Saline Replacement | 0 | 0 | $0.00 | |||||||||
| 0153 | IRL Transfusion Service | K5I | Transfusion Service tagging, PLT, IRL | 5 | 0 | 5 | $0.00 | ||||||||
| 0154 | IRL Transfusion Service | M5I | Immediate Spin crossmatch | 2 | 0 | 2 | $0.00 | ||||||||
| 0155 | IRL Transfusion Service | O5I | AGT phase of crossmatch | 3 | 0 | 3 | $0.00 | ||||||||
| 0156 | IRL Transfusion Service | Q5I | Frozen plasma thawing | 4 | 4 | $0.00 | |||||||||
| 0157 | Molecular Testing | SR81400A | 81105 HPA-1 Antigen Genotyping, SSP | 2 | 0 | 2 | $0.00 | ||||||||
| 0158 | Molecular Testing | SREF200A | 81403 ABO Genotyping, common alleles, SNP ID by RFLP | 9 | 2 | 0 | 11 | $0.00 | |||||||
| 0159 | Molecular Testing | SREF200B | 81403 RHD SNP detection by RFLP | 14 | 3 | 2 | 0 | 19 | $0.00 | ||||||
| 0160 | Molecular Testing | SREF200C | 81403 RHCE SNP by RFLP | 0 | 0 | $0.00 | |||||||||
| 0161 | Molecular Testing | SREF200D | 81403 RHD Zygosity PstI PCR RFLP | 0 | 0 | $0.00 | |||||||||
| 0162 | Molecular Testing | SREF250A | 81403 ABO common alleles, by SSP | 2 | 0 | 2 | $0.00 | ||||||||
| 0163 | Molecular Testing | SREF250B | 81403 RHD pseudogene & 455C by SSP | 0 | 0 | $0.00 | |||||||||
| 0164 | Molecular Testing | SREF250D | 81403 Multiplex PCR, partial RHD | 3 | 0 | 3 | $0.00 | ||||||||
| 0165 | Molecular Testing | SREF250E | 81403 RHD deletion detection, by SSP | 3 | 0 | 3 | $0.00 | ||||||||
| 0166 | Molecular Testing | SREF250H | Multiplex PCR, Big C, Little C, RHD Psi, exon 4 and 7 | 3 | 0 | 3 | $0.00 | ||||||||
| 0167 | Molecular Testing | SREF250J | 81403 Kidd genotyping, c.130 SSP | 3 | 0 | 3 | $0.00 | ||||||||
| 0168 | Molecular Testing | SREF32 | NML Sample, Urgent, routine hours | 0 | $0.00 | ||||||||||
| 0169 | Molecular Testing | SREF500B | 81403 Sanger Sequencing, 2-5 exons ART4 | 0 | 0 | $0.00 | |||||||||
| 0170 | Molecular Testing | SREF500C | 81403 Sanger Sequencing, 2-5 exons RHCE | 0 | 0 | $0.00 | |||||||||
| 0171 | Molecular Testing | SREF500D | 81403 Sanger Sequencing, 2-5 exons RHD | 0 | 0 | $0.00 | |||||||||
| 0172 | Molecular Testing | SREF500F | 81403 Sanger Sequencing, 2-5 exons ACKR1 | 0 | 0 | $0.00 | |||||||||
| 0173 | Molecular Testing | SREF500G | 81403 Sanger Sequencing, 2-5 exons glycophorin exons | 0 | 0 | $0.00 | |||||||||
| 0174 | Molecular Testing | SREF500J | 81403 Sanger Sequencing, 2-5 exons SLC14A1 | 0 | 0 | $0.00 | |||||||||
| 0175 | Molecular Testing | SREF500K | 81403 Sanger Sequencing, 2-5 exons KEL | 0 | 0 | $0.00 | |||||||||
| 0176 | Molecular Testing | SREF500L | 81403 Sanger Sequencing, 2-5 exons BCAM | 0 | 0 | $0.00 | |||||||||
| 0177 | Molecular Testing | SREF500N | 81403 Sanger Sequencing, 2-5 exons CR1 | 0 | 0 | $0.00 | |||||||||
| 0178 | Molecular Testing | SREF500R | 81403 Sanger Sequencing, 2-5 exons CROM | 0 | 0 | $0.00 | |||||||||
| 0179 | Molecular Testing | SREF500T | 81403 Sanger Sequencing, 2-5 exons KLF1 | 0 | 0 | $0.00 | |||||||||
| 0180 | Molecular Testing | SREF500X | 81403 Sanger Sequencing, 2-5 exons XK | 0 | 0 | $0.00 | |||||||||
| 0181 | Molecular Testing | SREF550A | 81403 Sanger Sequencing, 6-10 exons, ABO | 0 | 0 | $0.00 | |||||||||
| 0182 | Molecular Testing | SREF550C | 81403 Sanger Sequencing, 6-10 exons RHCE | 0 | 0 | $0.00 | |||||||||
| 0183 | Molecular Testing | SREF550D | 81403 Sanger Sequencing, 6-10 exons RHD | 0 | 0 | $0.00 | |||||||||
| 0184 | Molecular Testing | SREF550G | 81403 Sanger Sequencing, 6-10 exons glycophorin exons | 0 | 0 | $0.00 | |||||||||
| 0185 | Molecular Testing | SREF550J | 81403 Sanger Sequencing, 6-10 exons SLC14A1 | 0 | 0 | $0.00 | |||||||||
| 0186 | Molecular Testing | SREF550K | 81403 Sanger Sequencing, 6-10 exons KEL | 0 | 0 | $0.00 | |||||||||
| 0187 | Molecular Testing | SREF550L | 81403 Sanger Sequencing, 6-10 exons BCAM | 0 | 0 | $0.00 | |||||||||
| 0188 | Molecular Testing | SREF60 | 81479-Miscellaneous Molecular Testing | 0 | 0 | $0.00 | |||||||||
| 0189 | Molecular Testing | SREF600K | 81403 Sanger Sequencing, 11-25 exons, KEL | 0 | 0 | $0.00 | |||||||||
| 0190 | Molecular Testing | SREF600L | 81403 Sanger Sequencing, 11-25 exons, BCAM | 0 | 0 | $0.00 | |||||||||
| 0191 | Molecular Testing | SREF750C | 81403 cDNA analysis (high resolution), RHCE | 0 | 0 | $0.00 | |||||||||
| 0192 | Molecular Testing | SREF750D | 81403 cDNA analysis (high resolution), RHD | 0 | 0 | $0.00 | |||||||||
| 0193 | Molecular Testing | SREF750G | 81403 cDNA analysis (high resolution), glycophorins | 0 | 0 | $0.00 | |||||||||
| 0194 | Molecular Testing | SREF750J | 81403 cDNA analysis (high resolution), SLC14A1 | 0 | 0 | $0.00 | |||||||||
| 0195 | Molecular Testing | SREF750K | 81403 cDNA analysis (high resolution), KEL | 0 | 0 | $0.00 | |||||||||
| 0196 | Molecular Testing | SREF750L | 81403 cDNA analysis (high resolution), BCAM | 0 | 0 | $0.00 | |||||||||
| 0197 | Molecular Testing | SREFABRT | 81403 ABO genotyping | 0 | 0 | $0.00 | |||||||||
| 0198 | Molecular Testing | SREFFUT1 | 81403 Sanger Sequencing of FUT1 exon 4 | 0 | 0 | $0.00 | |||||||||
| 0199 | Molecular Testing | SREFFUT2 | 81403 Sanger Sequencing of FUT2 exon 2 | 0 | 0 | $0.00 | |||||||||
| 0200 | Molecular Testing | SREFHPRT | HPA Panel (replaces HP15, HPA2,3,4,5,6,9) | 0 | 0 | $0.00 | |||||||||
| 0201 | Molecular Testing | SREF-IVD | 0001U xHEA licensed RBC panel | 1 | 0 | 1 | $0.00 | ||||||||
| 0202 | Molecular Testing | SREF-RHB | 81403x2 Full RH genotyping (replaces SREF-RHD & SREF-450) | 4 | 2 | 1 | 0 | 7 | $0.00 | ||||||
| 0203 | Molecular Testing | SREF-RHZ | 81403 RHD Hybrid Rhesus Box detection | 0 | 0 | $0.00 | |||||||||
| 0204 | Molecular Testing | SREFSEQB | 81403 Sanger Sequencing, 1 exon ART4 | 0 | 0 | $0.00 | |||||||||
| 0205 | Molecular Testing | SREFSEQC | 81403 Sanger Sequencing, 1 exon RHCE | 0 | 0 | $0.00 | |||||||||
| 0206 | Molecular Testing | SREFSEQD | 81403 Sanger Sequencing, 1 exon RHD | 0 | 0 | $0.00 | |||||||||
| 0207 | Molecular Testing | SREFSEQF | 81403 Sanger Sequencing, 1 exon ACKR1 | 0 | 0 | $0.00 | |||||||||
| 0208 | Molecular Testing | SREFSEQJ | 81403 Sanger Sequencing, 1 exon SLC14A1 | 0 | 0 | $0.00 | |||||||||
| 0209 | Molecular Testing | SREFSEQK | 81403 Sanger Sequencing, 1 exon KEL | 0 | 0 | $0.00 | |||||||||
| 0210 | Molecular Testing | SREFSEQL | 81403 Sanger Sequencing, 1 exon BCAM | 0 | 0 | $0.00 | |||||||||
| 0211 | Molecular Testing | SREFSEQT | 81403 Sanger Sequencing, 1 exon KLF1 | 0 | 0 | $0.00 | |||||||||
| 0212 | Molecular Testing | SREFSEQX | 81403 Sanger Sequencing, 1 exon XK | 0 | 0 | $0.00 | |||||||||
| 0213 | Molecular Testing | SREFSEQY | 81403 Sanger Sequencing, 1 exon ACHE | 0 | 0 | $0.00 | |||||||||
| 0214 | Molecular Testing | SREFSQGA | 81403 Sanger Sequencing, 1 exon glycophorin GYPA | 0 | 0 | $0.00 | |||||||||
| 0215 | Molecular Testing | SREFSQGB | 81403 Sanger Sequencing, 1 exon glycophorin GYPB | 0 | 0 | $0.00 | |||||||||
| 0216 | Neutrophil | 86021 | Neutrophil Antibody Identification | 0 | 0 | $0.00 | |||||||||
| 0217 | Neutrophil | 88102 | Neutrophil Crossmatch | 0 | 0 | $0.00 | |||||||||
| 0218 | Neutrophil | N86022 | Platelet crossmatch, NEU | 0 | 0 | $0.00 | |||||||||
| 0219 | Neutrophil | NEU01 | Neutrophil Ag typing, Serology, NEU | 0 | 0 | $0.00 | |||||||||
| 0220 | Neutrophil | NEU03 | HPA-1a antigen phenotyping | 0 | 0 | $0.00 | |||||||||
| 0221 | Neutrophil | NEU04 | Platelet antibody screen, ELISA | 0 | 0 | $0.00 | |||||||||
| 0222 | Neutrophil | NEU05 | Drug Dependent Neutrophil Antibody | 0 | 0 | $0.00 | |||||||||
| 0223 | Neutrophil | NEU06 | Extended Ab ID (MAINA) | 0 | 0 | $0.00 | |||||||||
| 0224 | Neutrophil | NEU08 | Platelet Antibody Identification | 0 | 0 | $0.00 | |||||||||
| 0225 | Neutrophil | NEU11 | National Neutrophil Lab Referral fee | 0 | 0 | $0.00 | |||||||||
| 0226 | Neutrophil | NNEUT1 | 81479 HNA-1a/1b/1c | 0 | 0 | $0.00 | |||||||||
| 0227 | Neutrophil | NNEUT3 | 81479 HNA-3a/3b | 0 | 0 | $0.00 | |||||||||
| 0228 | Neutrophil | NNEUT4 | 81479 HNA-4a/4bw | 0 | 0 | $0.00 | |||||||||
| 0229 | Neutrophil | NNEUT5 | 81479 HNA-5a/5bw | 0 | 0 | $0.00 | |||||||||
| 0230 | Neutrophil | NNEUT99 | 81479 HNA Panel (HNA-1, 3, 4, 5) | 0 | 0 | $0.00 | |||||||||
| 0231 | Neutrophil | XMPLT | Platelet Crossmatch Incompatibility Screen | 0 | 0 | $0.00 | |||||||||
| 0232 | Product Related | C6I | Anti-CMV negative, per test | 2 | 2 | 2 | 0 | 6 | $0.00 | ||||||
| 0233 | Product Related | M1M | Unit W/1 Empty Bag - EMP1 | 0 | 0 | $0.00 | |||||||||
| 0234 | Product Related | N1M | Unit W/2 Empty Bag - EMP2 | 0 | 0 | $0.00 | |||||||||
| 0235 | Product Related | O1M | Unit W/3 Empty Bag - EMP3 | 0 | 0 | $0.00 | |||||||||
| 0236 | Product Related | P1M | Unit W/4 Empty Bag - EMP4 | 0 | 0 | $0.00 | |||||||||
| 0237 | Product Related | Q1M | Unit Less than 14 Days | 0 | 0 | $0.00 | |||||||||
| 0238 | Product Related | T1M | Unit Less than 48 Hours | 0 | 0 | $0.00 | |||||||||
| 0239 | Product Related | U1M | Unit Less than 5 Days | 0 | 0 | $0.00 | |||||||||
| 0240 | Product Related | V1M | Unit Less than 6 Days | 0 | 0 | $0.00 | |||||||||
| 0241 | Product Related | Y3M | Pedi Unit | 0 | 0 | $0.00 | |||||||||
| 0242 | Therapeutics | THAP100 | THAP: PLASMAPHERESIS | 80 | 200 | 0 | 0 | 280 | $0.00 | ||||||
| 0243 | Therapeutics | THAP110 | THAP: PHOTOPHERESIS CANCELLATION FEE - AFTER SET-UP | 2 | 0 | 0 | 2 | $0.00 | |||||||
| 0244 | Therapeutics | THAP112 | THAP: AFTER-HOURS / WEEKEND / HOLIDAY FEE | 10 | 12 | 0 | 0 | 22 | $0.00 | ||||||
| 0245 | Therapeutics | THAP114 | THAP: ADDITIONAL HOURS FEE | 0 | 0 | $0.00 | |||||||||
| 0246 | Therapeutics | THAP116 | THAP: STAT / RUSH FEE | 0 | 0 | $0.00 | |||||||||
| 0247 | Therapeutics | THAP117 | THAP: ARC PERSONNEL TIME - REQUIRED ORIENTATION - PER 15 MINUTES | 0 | 0 | $0.00 | |||||||||
| 0248 | Therapeutics | THAP119 | THAP: CVC DRESSING CHANGE | 0 | 0 | $0.00 | |||||||||
| 0249 | Therapeutics | THAP126 | THAP: THERAPEUTIC PHLEBOTOMY | 0 | 0 | $0.00 | |||||||||
| 0250 | Therapeutics | THAP129 | THAP: THROMBOCYTAPHERESIS | 0 | 0 | $0.00 | |||||||||
| 0251 | Therapeutics | THAP130 | THAP: ERYTHROCYTAPHERESIS | 0 | 0 | $0.00 | |||||||||
| 0252 | Therapeutics | THAP133 | THAP: LEUKOCYTAPHERESIS | 0 | 0 | $0.00 | |||||||||
| 0253 | Therapeutics | THAP150 | THAP: CANCELLATION FEE - BEFORE SETUP | 0 | 0 | $0.00 | |||||||||
| 0254 | Therapeutics | THAP151 | THAP: CANCELLATION FEE - AFTER SET-UP | 0 | 0 | $0.00 | |||||||||
| 0255 | Therapeutics | THAP170 | THAP: STAND-BY FEE - PER 15 MINUTES | 0 | 0 | $0.00 | |||||||||
| 0256 | TRANSPORTATION | TRANSPORTATION OF SPECIMENS AND/OR DONOR UNITS | 0 | $0.00 | |||||||||||
| 0257 | Albumin 250 ml | 750 | 750 | $0.00 | |||||||||||
| 0258 | Ag Neg Low Incidence | 0 | $0.00 | ||||||||||||
| 0259 | Ag Neg Unit <1% Freq | 21 | 21 | $0.00 | |||||||||||
| 0260 | Ag Neg Unit 1% Freq | 5 | 5 | $0.00 | |||||||||||
| 0261 | Ag Neg Unit 2% Freq | 5 | 3 | 5 | 13 | $0.00 | |||||||||
| 0262 | Ag Neg Unit 4-6% Frq | 1 | 1 | 5 | 7 | $0.00 | |||||||||
| 0263 | Ag Neg Unit 7% Freq | 5 | 5 | $0.00 | |||||||||||
| 0264 | Ag Type Major Ag | 9 | 9 | $0.00 | |||||||||||
| 0265 | CMP Scr Neat Ag Neg | 1 | 1 | 2 | $0.00 | ||||||||||
| 0266 | Covid-19 Convalescent Plasma | 2 | 2 | $0.00 | |||||||||||
| 0267 | Elution Preparation | 13 | 13 | $0.00 | |||||||||||
| 0268 | HEA Panel Reflex | 2 | 2 | $0.00 | |||||||||||
| 0269 | Inhibition of Plasma | 1 | 1 | $0.00 | |||||||||||
| 0270 | Pre-Warm/Warm Wash | 8 | 10 | 18 | $0.00 | ||||||||||
| 0271 | RBC, CPDA-1,Lr | 5 | 5 | $0.00 | |||||||||||
| 0272 | RBC, CPDA-1,Lr,Irr | 4 | 4 | $0.00 | |||||||||||
| 0273 | Screen Gel | 7 | 7 | $0.00 | |||||||||||
| 0274 | Screen Rare | 1 | 1 | 2 | $0.00 | ||||||||||
| 0275 | Screen Tube | 20 | 20 | $0.00 | |||||||||||
| 0276 | Thermal Amplitude | 0 | $0.00 | ||||||||||||
| TOTAL | 1126 | 17 | 50 | 1175 | 170 | 79 | 428 | 60 | 3105 | $0.00 |
Ordering Year 3
| Ordering Year 3 4/1/2024 - 3/31/2025 | VISN 15 Blood Bank Products | ||||||||||||||
| TABLE 1 - BLOOD PRODUCTS | |||||||||||||||
| Line Items | BLOOD PRODUCTS, SERVICES, AND DELIVERY | FEE PER UNIT/SERVICE | Estimated Workload | ||||||||||||
| Kansas City VAMC | Estimated Workload Leavenworth VAMC | Estimated Workload Topeka VAMC | Estimated Workload Columbia VAMC | Estimated Workload Marion VAMC | Poplar Bluff VAMC | Estimated Workload St. Louis VAMC | Estimated Workload Wichita VAMC | VISN 15 GRAND TOTAL WORKLOAD | VISN 15 GRAND TOTAL COSTS | ||||||
| 0001 | 24 Hour Plasma | $0.00 | 350 | 7 | 15 | 372 | $0.00 | ||||||||
| 0002 | AB Cryo Surcharge | 175 | 175 | $0.00 | |||||||||||
| 0003 | AB Plasma Surcharge | 12 | 4 | 1 | 2 | 19 | $0.00 | ||||||||
| 0004 | Apheresis Platelets - Pathogen Reduced (SDP-PR) | 99 | 260 | 22 | 25 | 75 | 20 | 501 | $0.00 | ||||||
| 0005 | Apheresis Platelets (SDP LVDS) | 90 | 12 | 5 | 107 | $0.00 | |||||||||
| 0006 | AUTO Fee | 0 | $0.00 | ||||||||||||
| 0007 | Cryo Pools - AB Surcharge | 0 | $0.00 | ||||||||||||
| 0008 | Cryo Poor Plasma | 0 | $0.00 | ||||||||||||
| 0009 | Cryoprecipitate (Single) | 0 | $0.00 | ||||||||||||
| 0010 | Cryoprecipitate Pools | 40 | 4 | 50 | 5 | 65 | 2 | 166 | $0.00 | ||||||
| 0011 | Deglyced Fee | 2 | 5 | 7 | $0.00 | ||||||||||
| 0012 | DIRD Fee | 1 | 1 | $0.00 | |||||||||||
| 0013 | Expedited Processing Fee (J8B) | 10 | 5 | 5 | 20 | $0.00 | |||||||||
| 0014 | FFP | 500 | 20 | 15 | 15 | 5 | 225 | 780 | $0.00 | ||||||
| 0015 | FFP Divided (Pedi Units) | 1 | 1 | $0.00 | |||||||||||
| 0016 | Frozen Fee | 0 | $0.00 | ||||||||||||
| 0017 | Irradiation Charge | 20 | 2 | 2 | 200 | 6 | 150 | 380 | $0.00 | ||||||
| 0018 | Leukoreduced Red Blood Cells (RBC) | 971 | 125 | 110 | 1,600 | 250 | 25 | 1,800 | 275 | 5156 | $0.00 | ||||
| 0019 | Liquid Plasma | 0 | $0.00 | ||||||||||||
| 0020 | O_N Red Blood Cell Surcharge | 120 | 55 | 30 | 205 | $0.00 | |||||||||
| 0021 | O_P Red Blood Cell Surcharge | 85 | 85 | $0.00 | |||||||||||
| 0022 | PAS Apheresis Platelets (SDP LVDS) | 75 | 5 | 80 | $0.00 | ||||||||||
| 0023 | Routine Delivery Fee | 48 | 48 | $0.00 | |||||||||||
| 0024 | Unscheduled Delivery (Y8B) | 60 | 24 | 50 | 134 | $0.00 | |||||||||
| 0025 | Washed Fee | 2 | 5 | 7 | $0.00 | ||||||||||
| 0026 | Whole Blood LR | 5 | 5 | $0.00 | |||||||||||
| 0027 | Autologous Packed Red Cells | 0 | $0.00 | ||||||||||||
| 0028 | HLA Matched Single Donor Platelets | 1 | 1 | $0.00 | |||||||||||
| 0029 | Single Donor Platelets (Leukofiltered) | 29 | 13 | 4 | 46 | $0.00 | |||||||||
| 0 | $0.00 | ||||||||||||||
| TOTAL | 1,750 | 164 | 131 | 2,678 | 526 | 258 | 2,240 | 549 | 8296 | ERROR:#VALUE! | |||||
| TABLE 2- LABORATORY SERVICES | |||||||||||||||
| CLIN | Category | Product Code | Product Description | FEE PER UNIT/SERVICE | Kansas City VAMC | Leavenworth VAMC | Topeka VAMC | Columbia VAMC | Marion VAMC | Poplar Bluff VAMC | St. Louis VAMC | Wichita VAMC | VISN 15 GRAND TOTAL WORKLOAD | VISN 15 GRAND TOTAL COSTS | |
| 0030 | HLA Product-Related | A7I | HLA select XMat PLT; HLA | 2 | 3 | 1 | 1 | 7 | $0.00 | ||||||
| 0031 | HLA Product-Related | B7I | PLT Ag neg/other comp HLA | 3 | 0 | 3 | $0.00 | ||||||||
| 0032 | HLA Product-Related | C7I | HLA Select PLT Cat1: HLA | 3 | 0 | 3 | $0.00 | ||||||||
| 0033 | HLA Product-Related | K7I | HPA-1a/PLA1 Neg PLT HLA | 3 | 0 | 3 | $0.00 | ||||||||
| 0034 | HLA Product-Related | L7I | PLT AgNeg/not HPA1aNegHLA | 2 | 0 | 2 | $0.00 | ||||||||
| 0035 | HLA STAT | D7I | HLA STAT Product, routine hours | 3 | 0 | 3 | $0.00 | ||||||||
| 0036 | HLA STAT | G7I | HLA STAT Product, non-routine hours | 2 | 1 | 3 | $0.00 | ||||||||
| 0037 | HLA STAT | 755 | HLA STAT Sample, Routine Hours | 3 | 0 | 3 | $0.00 | ||||||||
| 0038 | HLA STAT | 756 | HLA STAT Sample, Non-Routine Hours | 2 | 2 | 1 | 0 | 5 | $0.00 | ||||||
| 0039 | HLA Testing | H86022 | PLATELET CROSSMATCH, PER TEST | 3 | 0 | 3 | $0.00 | ||||||||
| 0040 | HLA Testing | H86023 | HLA; SINGLE ANTIGEN | 3 | 1 | 4 | $0.00 | ||||||||
| 0041 | HLA Testing | HLA008 | HLA; SINGLE ANTIGEN | 3 | 0 | 3 | $0.00 | ||||||||
| 0042 | HLA Testing | HLA009 | HLA; ANTIBODY SCREENING | 3 | 0 | 3 | $0.00 | ||||||||
| 0043 | HLA Testing | HLA012 | HLA; PLATELET ALLOIMMUN SCREEN | 1 | 0 | 1 | $0.00 | ||||||||
| 0044 | HLA Testing | HLA025 | HLA; ANTIBODY SCREEN FOR TRANSFUSION, CLASS I | 2 | 3 | 1 | 0 | 6 | $0.00 | ||||||
| 0045 | HLA Testing | HLA033 | HLA; MOLECULAR AB TYPING | 3 | 0 | 3 | $0.00 | ||||||||
| 0046 | HLA Testing | HLA04 | PLATELET ANTIBODY SCREEN | 2 | 2 | 1 | 0 | 5 | $0.00 | ||||||
| 0047 | HLA Testing | HLA064 | HLA;ANTIGEN TEST/PLATELET | 2 | 2 | 1 | 0 | 5 | $0.00 | ||||||
| 0048 | HLA Testing | HLA072 | HLA: A&B TYPING-FOR PLT TRANSFUSION | 1 | 0 | 1 | $0.00 | ||||||||
| 0049 | HLA Testing | HLA108 | HLA; ANTIBODY SCREEN FOR TRANSPORT, CLASS I AND II | 2 | 0 | 2 | $0.00 | ||||||||
| 0050 | HLA Testing | HLA109 | HLA; ANTIBODY IDENTIFICATION, CLASS I, IgG | 3 | 0 | 3 | $0.00 | ||||||||
| 0051 | HLA Testing | HLA123 | HLA-A (INTERMED RESOLUTION) | 2 | 0 | 2 | $0.00 | ||||||||
| 0052 | HLA Testing | HLA124 | HLA-B (INTERMED RESOLUTION) | 2 | 0 | 2 | $0.00 | ||||||||
| 0053 | HLA Testing | HLA157 | HLA: ANTIBODY ANALYSIS C1q, CLASS I | 3 | 0 | 3 | $0.00 | ||||||||
| 0054 | HLA Testing | HLA162 | Platelet HLA Type inquiry, per unit | 2 | 0 | 2 | $0.00 | ||||||||
| 0055 | HLA Testing | HLA164 | HLA select XM PLT, IRL | 0 | 0 | $0.00 | |||||||||
| 0056 | IRL Ag Neg | A4I | RBC Ag neg 1 per unit | 10 | 3 | 25 | 0 | 38 | $0.00 | ||||||
| 0057 | IRL Ag Neg | B4I | RBC Ag neg 2 per unit | 20 | 3 | 5 | 4 | 32 | $0.00 | ||||||
| 0058 | IRL Ag Neg | C4I | RBC Ag neg 3 per unit | 6 | 1 | 0 | 30 | 0 | 37 | $0.00 | |||||
| 0059 | IRL Ag Neg | D4I | RBC Ag neg 4 per unit | 1 | 0 | 1 | $0.00 | ||||||||
| 0060 | IRL Ag Neg | E4I | RBC Ag neg 5 per unit | 15 | 0 | 15 | $0.00 | ||||||||
| 0061 | IRL Ag Neg | E5I | Hist Ag inquiry/unit | 3 | 25 | 0 | 28 | $0.00 | |||||||
| 0062 | IRL Ag Neg | F4I | RBC Ag neg 6 per unit | 0 | 0 | $0.00 | |||||||||
| 0063 | IRL Ag Neg | G4I | RBC Ag neg 7 per unit | 0 | 0 | $0.00 | |||||||||
| 0064 | IRL Ag Neg | H4I | RBC Ag neg 8 per unit | 0 | 0 | $0.00 | |||||||||
| 0065 | IRL Ag Neg | I4I | RBC Ag neg 9 per unit | 0 | 0 | $0.00 | |||||||||
| 0066 | IRL Ag Neg | N5I | Hist Ag/Ag NT/each Ag | 3 | 0 | 3 | $0.00 | ||||||||
| 0067 | IRL Ag Neg | R5I | Hist Ag/Ag unconf/each Ag | 3 | 0 | 3 | $0.00 | ||||||||
| 0068 | IRL Ag Neg | R7I | RBC Ag neg 10 per unit | 0 | 0 | $0.00 | |||||||||
| 0069 | IRL Ag Neg | S5I | Allele selected/unit | 2 | 0 | 2 | $0.00 | ||||||||
| 0070 | IRL Ag Neg | T5I | Molecular type/each Ag | 0 | 0 | $0.00 | |||||||||
| 0071 | IRL Ag Neg | U5I | Special contract Ag/unit | 0 | 0 | $0.00 | |||||||||
| 0072 | IRL Ag Neg | U7I | RBC Ag neg 11 per unit | 0 | 0 | $0.00 | |||||||||
| 0073 | IRL Ag Neg | V7I | RBC Ag neg 12 per unit | 0 | 0 | $0.00 | |||||||||
| 0074 | IRL Ag Neg | W5I | RBC Ag neg 13 per unit | 0 | 0 | $0.00 | |||||||||
| 0075 | IRL Miscellaneous | REF71 | IRL Education Activity | 0 | 0 | $0.00 | |||||||||
| 0076 | IRL Platelet | D6I | Plt Ag neg not HPA-1a IRL | 0 | 0 | $0.00 | |||||||||
| 0077 | IRL Platelet | G6I | HLA antigen selected platelet-Category 1 | 1 | 0 | 1 | $0.00 | ||||||||
| 0078 | IRL Platelet | H6I | HLA antigen selected platelet-Category 2 | 1 | 0 | 1 | $0.00 | ||||||||
| 0079 | IRL Platelet | I5I | HPA-1a/PLA1 Neg PLT IRL | 0 | 0 | $0.00 | |||||||||
| 0080 | IRL Platelet | I6I | HLA antigen selected platelet-Category 3 | 1 | 0 | 1 | $0.00 | ||||||||
| 0081 | IRL Platelet | J5I | PLT Component, crossmatch | 2 | 0 | 0 | 2 | $0.00 | |||||||
| 0082 | IRL Platelet | L5I | PLT Ab per test, IRL | 2 | 2 | 0 | 0 | 4 | $0.00 | ||||||
| 0083 | IRL Platelet | PLT03 | Platelet ag typing (Serology), IRL | 0 | 0 | $0.00 | |||||||||
| 0084 | IRL Platelet | PLT04 | Platelet antibody, ELISA/Flow cytometry, IRL | 1 | 0 | 1 | $0.00 | ||||||||
| 0085 | IRL Platelet | PLT06 | Platelet Antibody ID, PSIFT, IRL | 1 | 0 | 1 | $0.00 | ||||||||
| 0086 | IRL Platelet | PLT08 | Platelet Antibody Drug Incubation, IRL | 1 | 0 | 1 | $0.00 | ||||||||
| 0087 | IRL Platelet | PLT09 | Heparin induced Plt Ab work-up, IRL | 2 | 0 | 0 | 2 | $0.00 | |||||||
| 0088 | IRL Platelet | PLT10 | Heparin induced Plt Ab Confirm, IRL | 0 | 0 | $0.00 | |||||||||
| 0089 | IRL Platelet | PLT11 | National Platelet Lab Referral Fee | 0 | 0 | $0.00 | |||||||||
| 0090 | IRL Platelet | SR86023 | Platelet Associated Ig (Direct) | 2 | 0 | 0 | 2 | $0.00 | |||||||
| 0091 | IRL Platelet | Z5I | HLA select XM PLT, IRL | 0 | 0 | $0.00 | |||||||||
| 0092 | IRL Product-Related | A5I | ARDP high rare Ag/unit | 0 | 0 | $0.00 | |||||||||
| 0093 | IRL Product-Related | A6I | PLT AgNeg/other comp IRL | 0 | 0 | $0.00 | |||||||||
| 0094 | IRL Product-Related | B5I | Historic HgbS per unit | 2 | 1 | 0 | 3 | $0.00 | |||||||
| 0095 | IRL Product-Related | B6I | Hemoglobin S, per test | 10 | 0 | 10 | $0.00 | ||||||||
| 0096 | IRL Product-Related | D5I | Unit search fee for RBC | 2 | 0 | 2 | $0.00 | ||||||||
| 0097 | IRL Product-Related | F5I | Rare/uncommon pheno/unit | 6 | 6 | $0.00 | |||||||||
| 0098 | IRL Product-Related | G5I | Ag type hosp segment/Ag | 0 | 0 | $0.00 | |||||||||
| 0099 | IRL Product-Related | H5I | Ag Screen-pt serum/unit | 3 | 0 | 3 | $0.00 | ||||||||
| 0100 | IRL Product-Related | J4I | Ag Scrn, spec order 1-10 | 3 | 0 | 3 | $0.00 | ||||||||
| 0101 | IRL Product-Related | K4I | Ag Scrn, spec order 11-20 | 0 | 0 | $0.00 | |||||||||
| 0102 | IRL Product-Related | L4I | Ag Scrn, spec order 21-30 | 0 | 0 | $0.00 | |||||||||
| 0103 | IRL Product-Related | M4I | Ag Scrn, spec order 31-40 | 0 | 0 | $0.00 | |||||||||
| 0104 | IRL Product-Related | N4I | Ag Scrn, spec order 41-50 | 0 | 0 | $0.00 | |||||||||
| 0105 | IRL Product-Related | O4I | Ag Scrn, spec order 51-60 | 0 | 0 | $0.00 | |||||||||
| 0106 | IRL Product-Related | P4I | Ag Scrn, spec order 61-70 | 0 | 0 | $0.00 | |||||||||
| 0107 | IRL Product-Related | Q4I | Special Recruitment Prod | 0 | 0 | $0.00 | |||||||||
| 0108 | IRL Product-Related | V5I | Regionally-defined fee | 0 | 0 | $0.00 | |||||||||
| 0109 | IRL Product-Related | X5I | IgA deficient component | 0 | 0 | $0.00 | |||||||||
| 0110 | IRL Specialty Testing | REF40 | IgA Testing | 0 | 0 | $0.00 | |||||||||
| 0111 | IRL Specialty Testing | REF41 | Expedited IgA testing | 0 | 0 | $0.00 | |||||||||
| 0112 | IRL Specialty Testing | REF44 | Monocyte Monolayer Assay | 0 | 0 | $0.00 |
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .