D.1 Schedule of Service - Estimated Test Quantity.xlsx

XLSX spreadsheet 39 KB Posted Jul 17, 2024

Attached to: Q301 Stat Referral Laboratory Testing
Solicitation number: 36C26324Q0870
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 23

About this file

Written by GovTribe AI · Jul 17, 2024

This document is a combined synopsis/solicitation for commercial products and services issued by the Department of Veterans Affairs (VA) Veterans Health Administration Veterans Integrated Service Network 23. The VA is seeking to award a single Indefinite Quantity Contract (IDC) for Stat Referral Laboratory Testing and Consultation Services to support the Minneapolis, MN VA Health Care System.

The contract period of performance is from September 1, 2024, to August 31, 2029. The contractor must provide the required laboratory testing and consultation services as outlined in the Performance Work Statement. Offerors must be active in the System for Award Management (SAM) with the applicable NAICS code. Quotes are due by July 31, 2024, at 11:00 AM Central Time and should be submitted via email. The solicitation outlines the evaluation factors, submission requirements, and FAR provisions that will be used to assess offers.

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Other files

File	Type	Posted
36C26324Q0870_2.docx	DOCX document	Jul 30, 2024
D.5 Quality Assurance Surveillance Plan.pdf	PDF	Jul 17, 2024
D.4 WAGE DETERMINATION 2015-4945 HENNEPIN COUNTY, MN.pdf	PDF	Jul 17, 2024
36C26324Q0870.pdf	PDF	Jul 17, 2024
D.2 IMMIGRATION CERTIFICATION.pdf	PDF	Jul 17, 2024
36C26324Q0870_1.docx	DOCX document	Jul 17, 2024
D.3 ORGANIZATIONAL CONFLICT CERTIFICATE.pdf	PDF	Jul 17, 2024

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Ordering Period 1

Stat Lab Referral Testing POP 09/01/2024-08/31/2025
Item #	CPT CODE	Description/Part Number*	Estimated Qty	Price	Extended Amount
0001	87207	Acanthamoeba smear/sp stain	1		$ - 0
0002	85307	Activated Protein C Resistance	1		$ - 0
0003	TBD	Additional laboratory tests not yet developed or listed in Schedule of Items	1		$ - 0
0004	87206	AFB Stain	1		$ - 0
0005	80150	Amikacin	9		$ - 0
0006	87076	Anaerobic ID1	1		$ - 0
0007	87077	Bacterial ID (each organism)	23		$ - 0
0008	86146	Beta-2 Glycoprotein 1, IgA	1		$ - 0
0009	86146	Beta-2 Glycoprotein 1, IgG	1		$ - 0
0010	86146	Beta-2 Glycoprotein 1, IgM	1		$ - 0
0011	86334	Beta-2 Transferrin	4		$ - 0
0012	85335	Bethesda Assay for Factor 8	1		$ - 0
0013	85335	Bethesda Assay for Factor 9	1		$ - 0
0014	87798	Bordetella pertussis & paratussis by PCR	2		$ - 0
0015	86147	Cardiolipin Antibodies IgG	1		$ - 0
0016	86147	Cardiolipin Antibodies IgM	1		$ - 0
0017	86147	Cardiolipin Antibody, IgA	1		$ - 0
0018	87491	Chlamydia/Gonorrhea by PCR	2		$ - 0
0019	87591	Chlamydia/Gonorrhea by PCR	2		$ - 0
0020	82507	Citric Acid, 24 hour urine	120		$ - 0
0021	87497	CMV DNA, Quant by PCR	184		$ - 0
0022	83516	Collagen VII Antibodies IgG	2		$ - 0
0023	86162	Complement Activity Total CH50	9		$ - 0
0024	87015	Concentration any type infect agent	1		$ - 0
0025	87081	CRE Culture	3		$ - 0
0026	86334	Cryoglobulin Identification	50		$ - 0
0027	82595	Cryoglobulin, Quantitative	100		$ - 0
0028	87075	Culture Bact Anaerobic	1		$ - 0
0029	87075	Culture Cath tip anaerobic, foreign body	1		$ - 0
0030	87075	Culture CSF Anaerobic	1		$ - 0
0031	80158	Cyclosporine	114		$ - 0
0032	87496	Cytomegalovirus Qual PCR	4		$ - 0
0033	85379	D Dimer, Quantitative	1		$ - 0
0034	82638	Dibucaine Number	2		$ - 0
0035	88348	Electron Microscopy Kidney	1		$ - 0
0036	87498	Enterovirus by PCR on CSF	1		$ - 0
0037	87798	Epstein Barr Virus Qual PCR	1		$ - 0
0038	87799	Epstein-Barr Virus PCR non blood	5		$ - 0
0039	80169	Everolimus	4		$ - 0
0040	85260	Factor 10 Chromogenic	34		$ - 0
0041	82705	Fat Feces, Qualitative Random	7		$ - 0
0042	82710	Fat Feces, Quantitative Timed	2		$ - 0
0043	85384	Fibrinogen, Activity	1		$ - 0
0044	88271	FISH INTERPHASE PROBE	1		$ - 0
0045	88275	FISH Interphase Interp	1		$ - 0
0046	87107	Fungal ID	1		$ - 0
0047	87186	Fungal Susceptibility Test (MIC)	1		$ - 0
0048	87205	Gram Stain	1		$ - 0
0049	83520	Granulocyte Colony Stimulating Factor	1		$ - 0
0050	83520	Granulocyte Macrophage CS Factor	1		$ - 0
0051	83051	Hemoglobin, Plasma	1		$ - 0
0052	81378	HLA ABC DR NGS	20		$ - 0
0053	81382	HLA Class II NGS	99		$ - 0
0054	87624	HPV High Risk and Low Risk Types DNA Tissue or Anal	3		$ - 0
0055	87624	HPV High Risk Types DNA Cervical	50		$ - 0
0056	87529	HSV 1/2 , Qualitative DNA by PCR, Plasma, Bronch Wash	117		$ - 0
0057	87529	HSV 1/2 by PCR Swab	67		$ - 0
0058	88342	IHC/CYTOCHEM stain TC	7		$ - 0
0059	88341	IHC/ICC Technical Component	15		$ - 0
0060	88350	Immunofluorescent stain Addl Kidney	2		$ - 0
0061	88346	Immunofluorescent stain kidney	1		$ - 0
0062	88341	Immunohistochem/immunocytochem PF	15		$ - 0
0063	85610	INR Protime	7		$ - 0
0064	83529	INTERLEUKIN 6	9		$ - 0
0065	82010	Ketone Beta-Hydroxybutyrate Quantitative, Rapid	34		$ - 0
0066	85810	Macroglobulins	15		$ - 0
0067	87899	Malaria Screen, Rapid, Emergency	1		$ - 0
0068	87483	Meningitis Encephalitis Panel	14		$ - 0
0069	80204	Methotrexate	42		$ - 0
0070	81287	MGMT Promoter Methylation testing	1		$ - 0
0071	87207	Microsporidium Stain	2		$ - 0
0072	88356	Morphometric Analysis nerve kdy	1		$ - 0
0073	87116	Mycobact culture isolate	1		$ - 0
0074	N/A	Neuropathology Autopsies	15		$ - 0
0075	88313	Non-organism stain Pro Fee	1		$ - 0
0076	88313	Non-organism stain TC	1		$ - 0
0077	82771	Occult Blood Gastric	2		$ - 0
0078	88312	Organism Stain TC	1		$ - 0
0079	83930	Osmo, Serum	10		$ - 0
0080	83935	Osmo, Stool	1		$ - 0
0081	83935	Osmo, Urine	3		$ - 0
0082	83945	Oxalic Acid, 24 hour urine	120		$ - 0
0083	87081	Parasite Culture	1		$ - 0
0084	87207	PARASITE STAIN	2		$ - 0
0085	87015	PARASITES THICK PREP	2		$ - 0
0086	88323	Path block consult Hemepath PF	1		$ - 0
0087	88323	Path block consult Pro Fee	4		$ - 0
0088	88323	Path block consult TC	4		$ - 0
0089	88323	Path block consult, Hemepath TC	1		$ - 0
0090	88321	Path Consultation Slide Review	3		$ - 0
0091	80184	Phenobarbital	3		$ - 0
0092	85420	Plasminogen Chromogenic	1		$ - 0
0093	85576	Platelet Function Closure Time, Collagen/ADP	7		$ - 0
0094	85576	Platelet Function Closure Time, Collagen/Epi	10		$ - 0
0095	85576	Platelet Function P2Y12 (Verify Now)	17		$ - 0
0096	82657	Porphobilinogen Deaminase, RBC	1		$ - 0
0097	80188	Primidone	5		$ - 0
0098	80184	Primidone and Metabolite/Phenobarbital	5		$ - 0
0099	82480	Pseudocholinesterase Total (with Dibucaine)	2		$ - 0
0100	85730	PTT, Activated	1		$ - 0
0101	80195	Rapamycin (Sirolimus)	44		$ - 0
0102	88321	Review outside slides Pro Fee	2		$ - 0
0103	87186	Sensitivities, MIC	11		$ - 0
0104	88312	Special stain for organism Pro Fee	1		$ - 0
0105	87181	Specific Antibiotic Sens Panel	17		$ - 0
0106	80299	Sulfonylurea Screen	4		$ - 0
0107	88305	Surg Path Level IV Kidney	1		$ - 0
0108	88314	Surg Path Level IV TC EM lab	1		$ - 0
0109	87186	Susceptibility Fungus by Broth	6		$ - 0
0110	83516	Synovasure	10		$ - 0
0111	86140	Synovasure CRP	10		$ - 0
0112	80197	Tacrolimus (FK-506) (Prograff)	1067		$ - 0
0113	80200	Tobramycin	2		$ - 0
0114	87798	Ureaplasma species by PCR	2		$ - 0
0115	87563	Urogenital Ureaplasma and Mycoplasma Species by PCR	2		$ - 0
0116	87798	Varicella Zoster Virus by PCR-Qualitative	44		$ - 0
0117	87252	Viral Culture - Non Respiratory	91		$ - 0
0118	87252	Viral Culture - Respiratory	46		$ - 0
0119	87106	Yeast ID1	11		$ - 0
				Total	$ - 0

Ordering Period 2

Stat Lab Referral Testing POP 09/01/2025-08/31/2026
Item #	CPT CODE	Description/Part Number*	Estimated Qty	Price	Extended Amount
1001	87207	Acanthamoeba smear/sp stain	1		$ - 0
1002	85307	Activated Protein C Resistance	1		$ - 0
1003	TBD	Additional laboratory tests not yet developed or listed in Schedule of Items	1		$ - 0
1004	87206	AFB Stain	1		$ - 0
1005	80150	Amikacin	9		$ - 0
1006	87076	Anaerobic ID1	1		$ - 0
1007	87077	Bacterial ID (each organism)	23		$ - 0
1008	86146	Beta-2 Glycoprotein 1, IgA	1		$ - 0
1009	86146	Beta-2 Glycoprotein 1, IgG	1		$ - 0
1010	86146	Beta-2 Glycoprotein 1, IgM	1		$ - 0
1011	86334	Beta-2 Transferrin	4		$ - 0
1012	85335	Bethesda Assay for Factor 8	1		$ - 0
1013	85335	Bethesda Assay for Factor 9	1		$ - 0
1014	87798	Bordetella pertussis & paratussis by PCR	2		$ - 0
1015	86147	Cardiolipin Antibodies IgG	1		$ - 0
1016	86147	Cardiolipin Antibodies IgM	1		$ - 0
1017	86147	Cardiolipin Antibody, IgA	1		$ - 0
1018	87491	Chlamydia/Gonorrhea by PCR	2		$ - 0
1019	87591	Chlamydia/Gonorrhea by PCR	2		$ - 0
1020	82507	Citric Acid, 24 hour urine	120		$ - 0
1021	87497	CMV DNA, Quant by PCR	184		$ - 0
1022	83516	Collagen VII Antibodies IgG	2		$ - 0
1023	86162	Complement Activity Total CH50	9		$ - 0
1024	87015	Concentration any type infect agent	1		$ - 0
1025	87081	CRE Culture	3		$ - 0
1026	86334	Cryoglobulin Identification	50		$ - 0
1027	82595	Cryoglobulin, Quantitative	100		$ - 0
1028	87075	Culture Bact Anaerobic	1		$ - 0
1029	87075	Culture Cath tip anaerobic, foreign body	1		$ - 0
1030	87075	Culture CSF Anaerobic	1		$ - 0
1031	80158	Cyclosporine	114		$ - 0
1032	87496	Cytomegalovirus Qual PCR	4		$ - 0
1033	85379	D Dimer, Quantitative	1		$ - 0
1034	82638	Dibucaine Number	2		$ - 0
1035	88348	Electron Microscopy Kidney	1		$ - 0
1036	87498	Enterovirus by PCR on CSF	1		$ - 0
1037	87798	Epstein Barr Virus Qual PCR	1		$ - 0
1038	87799	Epstein-Barr Virus PCR non blood	5		$ - 0
1039	80169	Everolimus	4		$ - 0
1040	85260	Factor 10 Chromogenic	34		$ - 0
1041	82705	Fat Feces, Qualitative Random	7		$ - 0
1042	82710	Fat Feces, Quantitative Timed	2		$ - 0
1043	85384	Fibrinogen, Activity	1		$ - 0
1044	88271	FISH INTERPHASE PROBE	1		$ - 0
1045	88275	FISH Interphase Interp	1		$ - 0
1046	87107	Fungal ID	1		$ - 0
1047	87186	Fungal Susceptibility Test (MIC)	1		$ - 0
1048	87205	Gram Stain	1		$ - 0
1049	83520	Granulocyte Colony Stimulating Factor	1		$ - 0
1050	83520	Granulocyte Macrophage CS Factor	1		$ - 0
1051	83051	Hemoglobin, Plasma	1		$ - 0
1052	81378	HLA ABC DR NGS	20		$ - 0
1053	81382	HLA Class II NGS	99		$ - 0
1054	87624	HPV High Risk and Low Risk Types DNA Tissue or Anal	3		$ - 0
1055	87624	HPV High Risk Types DNA Cervical	50		$ - 0
1056	87529	HSV 1/2 , Qualitative DNA by PCR, Plasma, Bronch Wash	117		$ - 0
1057	87529	HSV 1/2 by PCR Swab	67		$ - 0
1058	88342	IHC/CYTOCHEM stain TC	7		$ - 0
1059	88341	IHC/ICC Technical Component	15		$ - 0
1060	88350	Immunofluorescent stain Addl Kidney	2		$ - 0
1061	88346	Immunofluorescent stain kidney	1		$ - 0
1062	88341	Immunohistochem/immunocytochem PF	15		$ - 0
1063	85610	INR Protime	7		$ - 0
1064	83529	INTERLEUKIN 6	9		$ - 0
1065	82010	Ketone Beta-Hydroxybutyrate Quantitative, Rapid	34		$ - 0
1066	85810	Macroglobulins	15		$ - 0
1067	87899	Malaria Screen, Rapid, Emergency	1		$ - 0
1068	87483	Meningitis Encephalitis Panel	14		$ - 0
1069	80204	Methotrexate	42		$ - 0
1070	81287	MGMT Promoter Methylation testing	1		$ - 0
1071	87207	Microsporidium Stain	2		$ - 0
1072	88356	Morphometric Analysis nerve kdy	1		$ - 0
1073	87116	Mycobact culture isolate	1		$ - 0
1074	N/A	Neuropathology Autopsies	15		$ - 0
1075	88313	Non-organism stain Pro Fee	1		$ - 0
1076	88313	Non-organism stain TC	1		$ - 0
1077	82771	Occult Blood Gastric	2		$ - 0
1078	88312	Organism Stain TC	1		$ - 0
1079	83930	Osmo, Serum	10		$ - 0
1080	83935	Osmo, Stool	1		$ - 0
1081	83935	Osmo, Urine	3		$ - 0
1082	83945	Oxalic Acid, 24 hour urine	120		$ - 0
1083	87081	Parasite Culture	1		$ - 0
1084	87207	PARASITE STAIN	2		$ - 0
1085	87015	PARASITES THICK PREP	2		$ - 0
1086	88323	Path block consult Hemepath PF	1		$ - 0
1087	88323	Path block consult Pro Fee	4		$ - 0
1088	88323	Path block consult TC	4		$ - 0
1089	88323	Path block consult, Hemepath TC	1		$ - 0
1090	88321	Path Consultation Slide Review	3		$ - 0
1091	80184	Phenobarbital	3		$ - 0
1092	85420	Plasminogen Chromogenic	1		$ - 0
1093	85576	Platelet Function Closure Time, Collagen/ADP	7		$ - 0
1094	85576	Platelet Function Closure Time, Collagen/Epi	10		$ - 0
1095	85576	Platelet Function P2Y12 (Verify Now)	17		$ - 0
1096	82657	Porphobilinogen Deaminase, RBC	1		$ - 0
1097	80188	Primidone	5		$ - 0
1098	80184	Primidone and Metabolite/Phenobarbital	5		$ - 0
1099	82480	Pseudocholinesterase Total (with Dibucaine)	2		$ - 0
1100	85730	PTT, Activated	1		$ - 0
1101	80195	Rapamycin (Sirolimus)	44		$ - 0
1102	88321	Review outside slides Pro Fee	2		$ - 0
1103	87186	Sensitivities, MIC	11		$ - 0
1104	88312	Special stain for organism Pro Fee	1		$ - 0
1105	87181	Specific Antibiotic Sens Panel	17		$ - 0
1106	80299	Sulfonylurea Screen	4		$ - 0
1107	88305	Surg Path Level IV Kidney	1		$ - 0
1108	88314	Surg Path Level IV TC EM lab	1		$ - 0
1109	87186	Susceptibility Fungus by Broth	6		$ - 0
1110	83516	Synovasure	10		$ - 0
1111	86140	Synovasure CRP	10		$ - 0
1112	80197	Tacrolimus (FK-506) (Prograff)	1067		$ - 0
1113	80200	Tobramycin	2		$ - 0
1114	87798	Ureaplasma species by PCR	2		$ - 0
1115	87563	Urogenital Ureaplasma and Mycoplasma Species by PCR	2		$ - 0
1116	87798	Varicella Zoster Virus by PCR-Qualitative	44		$ - 0
1117	87252	Viral Culture - Non Respiratory	91		$ - 0
1118	87252	Viral Culture - Respiratory	46		$ - 0
1119	87106	Yeast ID1	11		$ - 0
				Total	$ - 0

Ordering Period 3

Stat Lab Referral Testing POP 09/01/2026-08/31/2027
Item #	CPT CODE	Description/Part Number*	Estimated Qty	Price	Extended Amount
2001	87207	Acanthamoeba smear/sp stain	1		$ - 0
2002	85307	Activated Protein C Resistance	1		$ - 0
2003	TBD	Additional laboratory tests not yet developed or listed in Schedule of Items	1		$ - 0
2004	87206	AFB Stain	1		$ - 0
2005	80150	Amikacin	9		$ - 0
2006	87076	Anaerobic ID1	1		$ - 0
2007	87077	Bacterial ID (each organism)	23		$ - 0
2008	86146	Beta-2 Glycoprotein 1, IgA	1		$ - 0
2009	86146	Beta-2 Glycoprotein 1, IgG	1		$ - 0
2010	86146	Beta-2 Glycoprotein 1, IgM	1		$ - 0
2011	86334	Beta-2 Transferrin	4		$ - 0
2012	85335	Bethesda Assay for Factor 8	1		$ - 0
2013	85335	Bethesda Assay for Factor 9	1		$ - 0
2014	87798	Bordetella pertussis & paratussis by PCR	2		$ - 0
2015	86147	Cardiolipin Antibodies IgG	1		$ - 0
2016	86147	Cardiolipin Antibodies IgM	1		$ - 0
2017	86147	Cardiolipin Antibody, IgA	1		$ - 0
2018	87491	Chlamydia/Gonorrhea by PCR	2		$ - 0
2019	87591	Chlamydia/Gonorrhea by PCR	2		$ - 0
2020	82507	Citric Acid, 24 hour urine	120		$ - 0
2021	87497	CMV DNA, Quant by PCR	184		$ - 0
2022	83516	Collagen VII Antibodies IgG	2		$ - 0
2023	86162	Complement Activity Total CH50	9		$ - 0
2024	87015	Concentration any type infect agent	1		$ - 0
2025	87081	CRE Culture	3		$ - 0
2026	86334	Cryoglobulin Identification	50		$ - 0
2027	82595	Cryoglobulin, Quantitative	100		$ - 0
2028	87075	Culture Bact Anaerobic	1		$ - 0
2029	87075	Culture Cath tip anaerobic, foreign body	1		$ - 0
2030	87075	Culture CSF Anaerobic	1		$ - 0
2031	80158	Cyclosporine	114		$ - 0
2032	87496	Cytomegalovirus Qual PCR	4		$ - 0
2033	85379	D Dimer, Quantitative	1		$ - 0
2034	82638	Dibucaine Number	2		$ - 0
2035	88348	Electron Microscopy Kidney	1		$ - 0
2036	87498	Enterovirus by PCR on CSF	1		$ - 0
2037	87798	Epstein Barr Virus Qual PCR	1		$ - 0
2038	87799	Epstein-Barr Virus PCR non blood	5		$ - 0
2039	80169	Everolimus	4		$ - 0
2040	85260	Factor 10 Chromogenic	34		$ - 0
2041	82705	Fat Feces, Qualitative Random	7		$ - 0
2042	82710	Fat Feces, Quantitative Timed	2		$ - 0
2043	85384	Fibrinogen, Activity	1		$ - 0
2044	88271	FISH INTERPHASE PROBE	1		$ - 0
2045	88275	FISH Interphase Interp	1		$ - 0
2046	87107	Fungal ID	1		$ - 0
2047	87186	Fungal Susceptibility Test (MIC)	1		$ - 0
2048	87205	Gram Stain	1		$ - 0
2049	83520	Granulocyte Colony Stimulating Factor	1		$ - 0
2050	83520	Granulocyte Macrophage CS Factor	1		$ - 0
2051	83051	Hemoglobin, Plasma	1		$ - 0
2052	81378	HLA ABC DR NGS	20		$ - 0
2053	81382	HLA Class II NGS	99		$ - 0
2054	87624	HPV High Risk and Low Risk Types DNA Tissue or Anal	3		$ - 0
2055	87624	HPV High Risk Types DNA Cervical	50		$ - 0
2056	87529	HSV 1/2 , Qualitative DNA by PCR, Plasma, Bronch Wash	117		$ - 0
2057	87529	HSV 1/2 by PCR Swab	67		$ - 0
2058	88342	IHC/CYTOCHEM stain TC	7		$ - 0
2059	88341	IHC/ICC Technical Component	15		$ - 0
2060	88350	Immunofluorescent stain Addl Kidney	2		$ - 0
2061	88346	Immunofluorescent stain kidney	1		$ - 0
2062	88341	Immunohistochem/immunocytochem PF	15		$ - 0
2063	85610	INR Protime	7		$ - 0
2064	83529	INTERLEUKIN 6	9		$ - 0
2065	82010	Ketone Beta-Hydroxybutyrate Quantitative, Rapid	34		$ - 0
2066	85810	Macroglobulins	15		$ - 0
2067	87899	Malaria Screen, Rapid, Emergency	1		$ - 0
2068	87483	Meningitis Encephalitis Panel	14		$ - 0
2069	80204	Methotrexate	42		$ - 0
2070	81287	MGMT Promoter Methylation testing	1		$ - 0
2071	87207	Microsporidium Stain	2		$ - 0
2072	88356	Morphometric Analysis nerve kdy	1		$ - 0
2073	87116	Mycobact culture isolate	1		$ - 0
2074	N/A	Neuropathology Autopsies	15		$ - 0
2075	88313	Non-organism stain Pro Fee	1		$ - 0
2076	88313	Non-organism stain TC	1		$ - 0
2077	82771	Occult Blood Gastric	2		$ - 0
2078	88312	Organism Stain TC	1		$ - 0
2079	83930	Osmo, Serum	10		$ - 0
2080	83935	Osmo, Stool	1		$ - 0
2081	83935	Osmo, Urine	3		$ - 0
2082	83945	Oxalic Acid, 24 hour urine	120		$ - 0
2083	87081	Parasite Culture	1		$ - 0
2084	87207	PARASITE STAIN	2		$ - 0
2085	87015	PARASITES THICK PREP	2		$ - 0
2086	88323	Path block consult Hemepath PF	1		$ - 0
2087	88323	Path block consult Pro Fee	4		$ - 0
2088	88323	Path block consult TC	4		$ - 0
2089	88323	Path block consult, Hemepath TC	1		$ - 0
2090	88321	Path Consultation Slide Review	3		$ - 0
2091	80184	Phenobarbital	3		$ - 0
2092	85420	Plasminogen Chromogenic	1		$ - 0
2093	85576	Platelet Function Closure Time, Collagen/ADP	7		$ - 0
2094	85576	Platelet Function Closure Time, Collagen/Epi	10		$ - 0
2095	85576	Platelet Function P2Y12 (Verify Now)	17		$ - 0
2096	82657	Porphobilinogen Deaminase, RBC	1		$ - 0
2097	80188	Primidone	5		$ - 0
2098	80184	Primidone and Metabolite/Phenobarbital	5		$ - 0
2099	82480	Pseudocholinesterase Total (with Dibucaine)	2		$ - 0
2100	85730	PTT, Activated	1		$ - 0
2101	80195	Rapamycin (Sirolimus)	44		$ - 0
2102	88321	Review outside slides Pro Fee	2		$ - 0
2103	87186	Sensitivities, MIC	11		$ - 0
2104	88312	Special stain for organism Pro Fee	1		$ - 0
2105	87181	Specific Antibiotic Sens Panel	17		$ - 0
2106	80299	Sulfonylurea Screen	4		$ - 0
2107	88305	Surg Path Level IV Kidney	1		$ - 0
2108	88314	Surg Path Level IV TC EM lab	1		$ - 0
2109	87186	Susceptibility Fungus by Broth	6		$ - 0
2110	83516	Synovasure	10		$ - 0
2111	86140	Synovasure CRP	10		$ - 0
2112	80197	Tacrolimus (FK-506) (Prograff)	1067		$ - 0
2113	80200	Tobramycin	2		$ - 0
2114	87798	Ureaplasma species by PCR	2		$ - 0
2115	87563	Urogenital Ureaplasma and Mycoplasma Species by PCR	2		$ - 0
2116	87798	Varicella Zoster Virus by PCR-Qualitative	44		$ - 0
2117	87252	Viral Culture - Non Respiratory	91		$ - 0
2118	87252	Viral Culture - Respiratory	46		$ - 0
2119	87106	Yeast ID1	11		$ - 0
				Total	$ - 0

Ordering Period 4

Stat Lab Referral Testing POP 09/01/2027-08/31/2028
Item #	CPT CODE	Description/Part Number*	Estimated Qty	Price	Extended Amount
3001	87207	Acanthamoeba smear/sp stain	1		$ - 0
3002	85307	Activated Protein C Resistance	1		$ - 0
3003	TBD	Additional laboratory tests not yet developed or listed in Schedule of Items	1		$ - 0
3004	87206	AFB Stain	1		$ - 0
3005	80150	Amikacin	9		$ - 0
3006	87076	Anaerobic ID1	1		$ - 0
3007	87077	Bacterial ID (each organism)	23		$ - 0
3008	86146	Beta-2 Glycoprotein 1, IgA	1		$ - 0
3009	86146	Beta-2 Glycoprotein 1, IgG	1		$ - 0
3010	86146	Beta-2 Glycoprotein 1, IgM	1		$ - 0
3011	86334	Beta-2 Transferrin	4		$ - 0
3012	85335	Bethesda Assay for Factor 8	1		$ - 0
3013	85335	Bethesda Assay for Factor 9	1		$ - 0
3014	87798	Bordetella pertussis & paratussis by PCR	2		$ - 0
3015	86147	Cardiolipin Antibodies IgG	1		$ - 0
3016	86147	Cardiolipin Antibodies IgM	1		$ - 0
3017	86147	Cardiolipin Antibody, IgA	1		$ - 0
3018	87491	Chlamydia/Gonorrhea by PCR	2		$ - 0
3019	87591	Chlamydia/Gonorrhea by PCR	2		$ - 0
3020	82507	Citric Acid, 24 hour urine	120		$ - 0
3021	87497	CMV DNA, Quant by PCR	184		$ - 0
3022	83516	Collagen VII Antibodies IgG	2		$ - 0
3023	86162	Complement Activity Total CH50	9		$ - 0
3024	87015	Concentration any type infect agent	1		$ - 0
3025	87081	CRE Culture	3		$ - 0
3026	86334	Cryoglobulin Identification	50		$ - 0
3027	82595	Cryoglobulin, Quantitative	100		$ - 0
3028	87075	Culture Bact Anaerobic	1		$ - 0
3029	87075	Culture Cath tip anaerobic, foreign body	1		$ - 0
3030	87075	Culture CSF Anaerobic	1		$ - 0
3031	80158	Cyclosporine	114		$ - 0
3032	87496	Cytomegalovirus Qual PCR	4		$ - 0
3033	85379	D Dimer, Quantitative	1		$ - 0
3034	82638	Dibucaine Number	2		$ - 0
3035	88348	Electron Microscopy Kidney	1		$ - 0
3036	87498	Enterovirus by PCR on CSF	1		$ - 0
3037	87798	Epstein Barr Virus Qual PCR	1		$ - 0
3038	87799	Epstein-Barr Virus PCR non blood	5		$ - 0
3039	80169	Everolimus	4		$ - 0
3040	85260	Factor 10 Chromogenic	34		$ - 0
3041	82705	Fat Feces, Qualitative Random	7		$ - 0
3042	82710	Fat Feces, Quantitative Timed	2		$ - 0
3043	85384	Fibrinogen, Activity	1		$ - 0
3044	88271	FISH INTERPHASE PROBE	1		$ - 0
3045	88275	FISH Interphase Interp	1		$ - 0
3046	87107	Fungal ID	1		$ - 0
3047	87186	Fungal Susceptibility Test (MIC)	1		$ - 0
3048	87205	Gram Stain	1		$ - 0
3049	83520	Granulocyte Colony Stimulating Factor	1		$ - 0
3050	83520	Granulocyte Macrophage CS Factor	1		$ - 0
3051	83051	Hemoglobin, Plasma	1		$ - 0
3052	81378	HLA ABC DR NGS	20		$ - 0
3053	81382	HLA Class II NGS	99		$ - 0
3054	87624	HPV High Risk and Low Risk Types DNA Tissue or Anal	3		$ - 0
3055	87624	HPV High Risk Types DNA Cervical	50		$ - 0
3056	87529	HSV 1/2 , Qualitative DNA by PCR, Plasma, Bronch Wash	117		$ - 0
3057	87529	HSV 1/2 by PCR Swab	67		$ - 0
3058	88342	IHC/CYTOCHEM stain TC	7		$ - 0
3059	88341	IHC/ICC Technical Component	15		$ - 0
3060	88350	Immunofluorescent stain Addl Kidney	2		$ - 0
3061	88346	Immunofluorescent stain kidney	1		$ - 0
3062	88341	Immunohistochem/immunocytochem PF	15		$ - 0
3063	85610	INR Protime	7		$ - 0
3064	83529	INTERLEUKIN 6	9		$ - 0
3065	82010	Ketone Beta-Hydroxybutyrate Quantitative, Rapid	34		$ - 0
3066	85810	Macroglobulins	15		$ - 0
3067	87899	Malaria Screen, Rapid, Emergency	1		$ - 0
3068	87483	Meningitis Encephalitis Panel	14		$ - 0
3069	80204	Methotrexate	42		$ - 0
3070	81287	MGMT Promoter Methylation testing	1		$ - 0
3071	87207	Microsporidium Stain	2		$ - 0
3072	88356	Morphometric Analysis nerve kdy	1		$ - 0
3073	87116	Mycobact culture isolate	1		$ - 0
3074	N/A	Neuropathology Autopsies	15		$ - 0
3075	88313	Non-organism stain Pro Fee	1		$ - 0
3076	88313	Non-organism stain TC	1		$ - 0
3077	82771	Occult Blood Gastric	2		$ - 0
3078	88312	Organism Stain TC	1		$ - 0
3079	83930	Osmo, Serum	10		$ - 0
3080	83935	Osmo, Stool	1		$ - 0
3081	83935	Osmo, Urine	3		$ - 0
3082	83945	Oxalic Acid, 24 hour urine	120		$ - 0
3083	87081	Parasite Culture	1		$ - 0
3084	87207	PARASITE STAIN	2		$ - 0
3085	87015	PARASITES THICK PREP	2		$ - 0
3086	88323	Path block consult Hemepath PF	1		$ - 0
3087	88323	Path block consult Pro Fee	4		$ - 0
3088	88323	Path block consult TC	4		$ - 0
3089	88323	Path block consult, Hemepath TC	1		$ - 0
3090	88321	Path Consultation Slide Review	3		$ - 0
3091	80184	Phenobarbital	3		$ - 0
3092	85420	Plasminogen Chromogenic	1		$ - 0
3093	85576	Platelet Function Closure Time, Collagen/ADP	7		$ - 0
3094	85576	Platelet Function Closure Time, Collagen/Epi	10		$ - 0
3095	85576	Platelet Function P2Y12 (Verify Now)	17		$ - 0
3096	82657	Porphobilinogen Deaminase, RBC	1		$ - 0
3097	80188	Primidone	5		$ - 0
3098	80184	Primidone and Metabolite/Phenobarbital	5		$ - 0
3099	82480	Pseudocholinesterase Total (with Dibucaine)	2		$ - 0
3100	85730	PTT, Activated	1		$ - 0
3101	80195	Rapamycin (Sirolimus)	44		$ - 0
3102	88321	Review outside slides Pro Fee	2		$ - 0
3103	87186	Sensitivities, MIC	11		$ - 0
3104	88312	Special stain for organism Pro Fee	1		$ - 0
3105	87181	Specific Antibiotic Sens Panel	17		$ - 0
3106	80299	Sulfonylurea Screen	4		$ - 0
3107	88305	Surg Path Level IV Kidney	1		$ - 0
3108	88314	Surg Path Level IV TC EM lab	1		$ - 0
3109	87186	Susceptibility Fungus by Broth	6		$ - 0
3110	83516	Synovasure	10		$ - 0
3111	86140	Synovasure CRP	10		$ - 0
3112	80197	Tacrolimus (FK-506) (Prograff)	1067		$ - 0
3113	80200	Tobramycin	2		$ - 0
3114	87798	Ureaplasma species by PCR	2		$ - 0
3115	87563	Urogenital Ureaplasma and Mycoplasma Species by PCR	2		$ - 0
3116	87798	Varicella Zoster Virus by PCR-Qualitative	44		$ - 0
3117	87252	Viral Culture - Non Respiratory	91		$ - 0
3118	87252	Viral Culture - Respiratory	46		$ - 0
3119	87106	Yeast ID1	11		$ - 0
				Total	$ - 0

Ordering Period 5

Stat Lab Referral Testing POP 09/01/2028-08/31/2029
Item #	CPT CODE	Description/Part Number*	Estimated Qty	Price	Extended Amount
4001	87207	Acanthamoeba smear/sp stain	1		$ - 0
4002	85307	Activated Protein C Resistance	1		$ - 0
4003	TBD	Additional laboratory tests not yet developed or listed in Schedule of Items	1		$ - 0
4004	87206	AFB Stain	1		$ - 0
4005	80150	Amikacin	9		$ - 0
4006	87076	Anaerobic ID1	1		$ - 0
4007	87077	Bacterial ID (each organism)	23		$ - 0
4008	86146	Beta-2 Glycoprotein 1, IgA	1		$ - 0
4009	86146	Beta-2 Glycoprotein 1, IgG	1		$ - 0
4010	86146	Beta-2 Glycoprotein 1, IgM	1		$ - 0
4011	86334	Beta-2 Transferrin	4		$ - 0
4012	85335	Bethesda Assay for Factor 8	1		$ - 0
4013	85335	Bethesda Assay for Factor 9	1		$ - 0
4014	87798	Bordetella pertussis & paratussis by PCR	2		$ - 0
4015	86147	Cardiolipin Antibodies IgG	1		$ - 0
4016	86147	Cardiolipin Antibodies IgM	1		$ - 0
4017	86147	Cardiolipin Antibody, IgA	1		$ - 0
4018	87491	Chlamydia/Gonorrhea by PCR	2		$ - 0
4019	87591	Chlamydia/Gonorrhea by PCR	2		$ - 0
4020	82507	Citric Acid, 24 hour urine	120		$ - 0
4021	87497	CMV DNA, Quant by PCR	184		$ - 0
4022	83516	Collagen VII Antibodies IgG	2		$ - 0
4023	86162	Complement Activity Total CH50	9		$ - 0
4024	87015	Concentration any type infect agent	1		$ - 0
4025	87081	CRE Culture	3		$ - 0
4026	86334	Cryoglobulin Identification	50		$ - 0
4027	82595	Cryoglobulin, Quantitative	100		$ - 0
4028	87075	Culture Bact Anaerobic	1		$ - 0
4029	87075	Culture Cath tip anaerobic, foreign body	1		$ - 0
4030	87075	Culture CSF Anaerobic	1		$ - 0
4031	80158	Cyclosporine	114		$ - 0
4032	87496	Cytomegalovirus Qual PCR	4		$ - 0
4033	85379	D Dimer, Quantitative	1		$ - 0
4034	82638	Dibucaine Number	2		$ - 0
4035	88348	Electron Microscopy Kidney	1		$ - 0
4036	87498	Enterovirus by PCR on CSF	1		$ - 0
4037	87798	Epstein Barr Virus Qual PCR	1		$ - 0
4038	87799	Epstein-Barr Virus PCR non blood	5		$ - 0
4039	80169	Everolimus	4		$ - 0
4040	85260	Factor 10 Chromogenic	34		$ - 0
4041	82705	Fat Feces, Qualitative Random	7		$ - 0
4042	82710	Fat Feces, Quantitative Timed	2		$ - 0
4043	85384	Fibrinogen, Activity	1		$ - 0
4044	88271	FISH INTERPHASE PROBE	1		$ - 0
4045	88275	FISH Interphase Interp	1		$ - 0
4046	87107	Fungal ID	1		$ - 0
4047	87186	Fungal Susceptibility Test (MIC)	1		$ - 0
4048	87205	Gram Stain	1		$ - 0
4049	83520	Granulocyte Colony Stimulating Factor	1		$ - 0
4050	83520	Granulocyte Macrophage CS Factor	1		$ - 0
4051	83051	Hemoglobin, Plasma	1		$ - 0
4052	81378	HLA ABC DR NGS	20		$ - 0
4053	81382	HLA Class II NGS	99		$ - 0
4054	87624	HPV High Risk and Low Risk Types DNA Tissue or Anal	3		$ - 0
4055	87624	HPV High Risk Types DNA Cervical	50		$ - 0
4056	87529	HSV 1/2 , Qualitative DNA by PCR, Plasma, Bronch Wash	117		$ - 0
4057	87529	HSV 1/2 by PCR Swab	67		$ - 0
4058	88342	IHC/CYTOCHEM stain TC	7		$ - 0
4059	88341	IHC/ICC Technical Component	15		$ - 0
4060	88350	Immunofluorescent stain Addl Kidney	2		$ - 0
4061	88346	Immunofluorescent stain kidney	1		$ - 0
4062	88341	Immunohistochem/immunocytochem PF	15		$ - 0
4063	85610	INR Protime	7		$ - 0
4064	83529	INTERLEUKIN 6	9		$ - 0
4065	82010	Ketone Beta-Hydroxybutyrate Quantitative, Rapid	34		$ - 0
4066	85810	Macroglobulins	15		$ - 0
4067	87899	Malaria Screen, Rapid, Emergency	1		$ - 0
4068	87483	Meningitis Encephalitis Panel	14		$ - 0
4069	80204	Methotrexate	42		$ - 0
4070	81287	MGMT Promoter Methylation testing	1		$ - 0
4071	87207	Microsporidium Stain	2		$ - 0
4072	88356	Morphometric Analysis nerve kdy	1		$ - 0
4073	87116	Mycobact culture isolate	1		$ - 0
4074	N/A	Neuropathology Autopsies	15		$ - 0
4075	88313	Non-organism stain Pro Fee	1		$ - 0
4076	88313	Non-organism stain TC	1		$ - 0
4077	82771	Occult Blood Gastric	2		$ - 0
4078	88312	Organism Stain TC	1		$ - 0
4079	83930	Osmo, Serum	10		$ - 0
4080	83935	Osmo, Stool	1		$ - 0
4081	83935	Osmo, Urine	3		$ - 0
4082	83945	Oxalic Acid, 24 hour urine	120		$ - 0
4083	87081	Parasite Culture	1		$ - 0
4084	87207	PARASITE STAIN	2		$ - 0
4085	87015	PARASITES THICK PREP	2		$ - 0
4086	88323	Path block consult Hemepath PF	1		$ - 0
4087	88323	Path block consult Pro Fee	4		$ - 0
4088	88323	Path block consult TC	4		$ - 0
4089	88323	Path block consult, Hemepath TC	1		$ - 0
4090	88321	Path Consultation Slide Review	3		$ - 0
4091	80184	Phenobarbital	3		$ - 0
4092	85420	Plasminogen Chromogenic	1		$ - 0
4093	85576	Platelet Function Closure Time, Collagen/ADP	7		$ - 0
4094	85576	Platelet Function Closure Time, Collagen/Epi	10		$ - 0
4095	85576	Platelet Function P2Y12 (Verify Now)	17		$ - 0
4096	82657	Porphobilinogen Deaminase, RBC	1		$ - 0
4097	80188	Primidone	5		$ - 0
4098	80184	Primidone and Metabolite/Phenobarbital	5		$ - 0
4099	82480	Pseudocholinesterase Total (with Dibucaine)	2		$ - 0
4100	85730	PTT, Activated	1		$ - 0
4101	80195	Rapamycin (Sirolimus)	44		$ - 0
4102	88321	Review outside slides Pro Fee	2		$ - 0
4103	87186	Sensitivities, MIC	11		$ - 0
4104	88312	Special stain for organism Pro Fee	1		$ - 0
4105	87181	Specific Antibiotic Sens Panel	17		$ - 0
4106	80299	Sulfonylurea Screen	4		$ - 0
4107	88305	Surg Path Level IV Kidney	1		$ - 0
4108	88314	Surg Path Level IV TC EM lab	1		$ - 0
4109	87186	Susceptibility Fungus by Broth	6		$ - 0
4110	83516	Synovasure	10		$ - 0
4111	86140	Synovasure CRP	10		$ - 0
4112	80197	Tacrolimus (FK-506) (Prograff)	1067		$ - 0
4113	80200	Tobramycin	2		$ - 0
4114	87798	Ureaplasma species by PCR	2		$ - 0
4115	87563	Urogenital Ureaplasma and Mycoplasma Species by PCR	2		$ - 0
4116	87798	Varicella Zoster Virus by PCR-Qualitative	44		$ - 0
4117	87252	Viral Culture - Non Respiratory	91		$ - 0
4118	87252	Viral Culture - Respiratory	46		$ - 0
4119	87106	Yeast ID1	11		$ - 0
				Total	$ - 0

File details come from the government source that posted it. Updated Jul 17, 2024.