CTR075690_Pricing.xlsx
XLSX spreadsheet 11 KB Posted
- Attached to
- Master Agreement AZ|CTR076390
- Contract number
- CTR076390
- Issued by
- Arizona
About this file
This document appears to be a pricing schedule for a state and local contract (Contract Number CTR075690) focused on specialized medical testing services, specifically newborn screening and genetic testing. The document is a detailed Excel spreadsheet listing various diagnostic tests performed using advanced laboratory techniques such as Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) and Polymerase Chain Reaction (PCR).
The contract covers 13 distinct line items for medical tests related to rare genetic disorders, including Homocystinuria, Maple Syrup Urine Disease, Tyrosinemia, Pompe Disease, Krabbe Disease, and various Mucopolysaccharidosis (MPS) conditions. Pricing ranges from $50 to $1,000 per test, with turnaround times varying between 1-20 days depending on the specific test. The tests utilize sophisticated molecular diagnostic methods and include both initial screening and full gene analysis options. Each test is associated with specific CPT codes, performance days, and a "MATCH" classification, suggesting a standardized approach to genetic and metabolic disorder screening.
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Other files
| File | Type | Posted |
|---|---|---|
| 2026-01-01 COI GL PL.pdf | ||
| 2026-01-01 COI WC.pdf | ||
| CTR075690_Contract_Documents.pdf | ||
| CTR076390_Amendment_One__1__fully_executed.pdf |
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Text version
Sheet1
| APP Line Item # | Name | Mayo Test # | Mayo Test Name | Fee per Test | Report Available* | Days Performed | CPT Codes | Match Type | ||
| (Referral – See Note Below) | Mayo Method | |||||||||
| CTR075690-1 | Homocystinuria, Methylmalonic acidemia, Propionic acidemia | HCMM | Homocysteine (Total), Methylmalonic Acid, and Methylcitric Acid, Dried Blood Spots | $50.00 | 3 to 6 days | Monday, Thursday | 83090, 83918 | MATCH | Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) | |
| CTR075690-2 | Glutarylcarnitine - Second (2nd) tier test | HGEM | Hydroxyglutaric Acids, Glutaric Acid, Ethylmalonic Acid, and Methylsuccinic Acid, Blood Spot | $60.00 | 3 to 7 days | Monday, Wednesday | 83918 | MATCH | Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) | |
| CTR075690-3 | Maple Syrup Urine Disease - Second (2nd) tier test | ALLOI | Allo-isoleucine, Blood Spots | $50.00 | 2 to 4 days | Monday through Friday | 82136 | MATCH | Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) | |
| CTR075690-4 | Tyrosinemia Type I - Second (2nd) tier test | SUAC | Succinylacetone, Blood Spots | $50.00 | 3 to 5 days | Monday through Friday | 82542, 84510 | MATCH | Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) | |
| CTR075690-5 | Disorder MPS I – Second (2nd) Tier Test Method LC-MS/MS | MPSBS | Mucopolysaccharidosis, Blood Spot | $62.00 | 3 to 5 days | Monday, Wednesday, Friday | 83864 | MATCH | Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) | |
| CTR075690-6 | Disorder MPS II – Second (2nd) Tier Test Method LC-MS/MS | $62.00 | ||||||||
| CTR075690-7 | Disorder Pompe – Second (2nd) Tier Test Method LC-MS/MS | PDBS / PD2T | Pompe Disease, Blood Spot | $150.00 | 2 to 3 days | Monday through Sunday | 83789 | MATCH | Flow Injection Analysis-Tandem Mass Spectrometry (FIA-MS/MS) | |
| CTR075690-8 | Psychosine, Blood Spot | PSY | Psychosine, Blood Spot | $62.00 | 1 to 2 days | Monday through Sunday | 82542 | MATCH | Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) | |
| CTR075690-9 | Krabbe Disease Second-Tier Newborn Screen, Blood Spot | KD2T | Krabbe Disease Second-Tier Newborn Screen, Blood Spot | $390.00 | 2 to 3 days | Monday through Saturday | 81401, 82542 | MATCH | Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS), PCR w/Gel Electrophoresis | |
| CTR075690-10 | Krabbe Disease, Full Gene Analysis and Large (30 kb) Deletion, Varies | KRABZ | Krabbe Disease, Full Gene Analysis and Large (30 kb) Deletion, Varies | $1,000.00 | 14 to 20 days | Varies | 81406 | MATCH | Polymerase Chain Reaction (PCR) Followed by DNA Sequence Analysis | |
| CTR075690-11 | Pompe Disease, Full Gene Analysis, Varies | GAAZ | Pompe Disease, Full Gene Analysis, Varies | $1,000.00 | 14 to 20 days | Varies | 81406 | MATCH | Polymerase Chain Reaction (PCR) Followed by DNA Sequence Analysis | |
| CTR075690-12 | Hurler Syndrome- MPS-I (IDUA Gene), Full Gene Analysis | MPS1Z | Hurler Syndrome- MPS-I (IDUA Gene), Full Gene Analysis | $1,000.00 | 14 to 20 days | Varies | 81406 | MATCH | Polymerase Chain Reaction (PCR) Followed by DNA Sequence Analysis | |
| CTR075690-13 | Hunter Syndrome- MPS-II (IDS Gene), Full Gene Analysis | MPS2Z | Hunter Syndrome- MPS-II (IDS Gene), Full Gene Analysis | $1,000.00 | 14 to 20 days | Varies | 81405 | MATCH | Polymerase Chain Reaction (PCR) followed by DNA Sequencing |
File details come from the government source that posted it. Updated .