Attachment_4-Exhibit_AC_Ordering_Period_3.pdf

Exhibit AC FA3010-16-R-0002 Attachment 4

Dated: 20 Oct 2015

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ESTIMATED

QUANTITY UNIT PRICE TOTAL PRICE

GENERAL CHEMISTRY

AC01 Cost Per Reportable Result GLYCOCYLATED HEMAGLOBIN A1C - No Pretreatment Required 14045 $ $

AC02 Cost Per Reportable Result ALBUMIN 31368 $ $

AC03 Cost Per Reportable Result AMMONIA 174 $ $

AC04 Cost Per Reportable Result AMYLASE 572 $ $

AC05 Cost Per Reportable Result ALKALINE PHOSPHATASE 23890 $ $

AC06 Cost Per Reportable Result ALANINE AMINOTRANSFERASE (ALT) 24577 $ $

AC07 Cost Per Reportable Result ASPARTATE AMINOTRANSFERASE (AST) 24850 $ $

AC08 Cost Per Reportable Result BLOOD UREA NITOGEN 42831 $ $

AC09 Cost Per Reportable Result CALCIUM 43125 $ $

AC10 Cost Per Reportable Result CHOLESTEROL 15139 $ $

AC11 Cost Per Reportable Result CREATINE KINASE - TOTAL 4499 $ $

AC12 Cost Per Reportable Result CREATININE 52874 $ $

AC13 Cost Per Reportable Result DIRECT BILIRUBIN 3514 $ $

AC14 Cost Per Reportable Result ALCOHOL 401 $ $

AC15 Cost Per Reportable Result FERRITIN 3308 $ $

AC16 Cost Per Reportable Result GAMMA-GLUTAMYL TRANSFERASE 326 $ $

AC17 Cost Per Reportable Result GLUCOSE 43104 $ $

AC18 Cost Per Reportable Result HIGH DENSITY LYPOPROTIEN - DIRECT 15117 $ $

AC19 Cost Per Reportable Result LOW DENSITY LYPOPROTIEN - DIRECT 15133 $ $

AC20 Cost Per Reportable Result IRON (NO PRETREATMENT) 4871 $ $

AC21 Cost Per Reportable Result LACTATE 1525 $ $

AC22 Cost Per Reportable Result LACTIC DEHYDROGENASE 947 $ $

AC23 Cost Per Reportable Result LIPASE 1770 $ $

AC24 Cost Per Reportable Result MAGNESIUM 7063 $ $

AC25 Cost Per Reportable Result PHOSPHOROUS 10171 $ $

AC26 Cost Per Reportable Result PREALBUMIN 129 $ $

AC27 Cost Per Reportable Result TOTAL BILIRUBIN 24458 $ $

AC28 Cost Per Reportable Result IRON BINDING CAPACITY 4849 $ $

AC29 Cost Per Reportable Result TOTAL PROTEIN 24226 $ $

CHEMISTRY & SPECIAL CHEMISTRY TESTING KEESLER AFB, MS

Ordering Period 3: 1 Apr 2018 - 31 Mar 2019

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ESTIMATED

QUANTITY UNIT PRICE TOTAL PRICE

CHEMISTRY & SPECIAL CHEMISTRY TESTING KEESLER AFB, MS

Ordering Period 3: 1 Apr 2018 - 31 Mar 2019

AC30 Cost Per Reportable Result TRANSFERRIN 4849 $ $

AC31 Cost Per Reportable Result TRIGLYCERIDE 15157 $ $

AC32 Cost Per Reportable Result URIC ACID 1580 $ $

ELECTROLYTES

AC33 Cost Per Reportable Result SODIUM 41789 $ $

AC34 Cost Per Reportable Result POTASSIUM 41772 $ $

AC35 Cost Per Reportable Result CHLORIDE 41328 $ $

AC36 Cost Per Reportable Result CARBON DIOXIDE 39880 $ $

IMMUNOCHEMISTRY

AC37 Cost Per Reportable Result 3RD GENERATION TOTAL PROSTATE SPECIFIC ANTIGEN (PSA) 2592 $ $

AC38 Cost Per Reportable Result 3RD GENERATION THYROID STYMULATING HORMONE (TSH) 14003 $ $

AC39 Cost Per Reportable Result ALPHA FETAL PROTIEN 191 $ $

AC40 Cost Per Reportable Result ANTI STREPTOLYSIN O (ASO) 26 $ $

AC41 Cost Per Reportable Result B12, VITAMIN 3097 $ $

AC42 Cost Per Reportable Result CA-125 ANTIGEN 100 $ $

AC43 Cost Per Reportable Result CARCINOEMBRYONIC ANTIGEN (CEA) 515 $ $

AC44 Cost Per Reportable Result CORTISOL 394 $ $

AC45 Cost Per Reportable Result TOTAL 25-HYDROXYVITAMIN D (TOTAL VITAMIN D) 6763 $ $

AC46 Cost Per Reportable Result ESTRADIOL 222 $ $

AC47 Cost Per Reportable Result FREE PSA 610 $ $

AC48 Cost Per Reportable Result FOLLICLE STIMULATING HORMONE (FSH) 583 $ $

AC49 Cost Per Reportable Result FREE THYROXINE (FT4) 5020 $ $

AC50 Cost Per Reportable Result FOLATE 3097 $ $

AC51 Cost Per Reportable Result Beta HUMAN CHORIONIC GONADOTROPIN (HCG) 842 $ $

AC52 Cost Per Reportable Result IMMUNOGLOBULIN A 291 $ $

AC53 Cost Per Reportable Result IMMUNOGLOBULIN G 291 $ $

AC54 Cost Per Reportable Result IMMUNOGLOBULIN M 291 $ $

AC55 Cost Per Reportable Result LUTEINIZING HORMONE (LH) 583 $ $

AC56 Cost Per Reportable Result PROGESTERONE 124 $ $

AC57 Cost Per Reportable Result PROLACTIN 1132 $ $

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ESTIMATED

QUANTITY UNIT PRICE TOTAL PRICE

CHEMISTRY & SPECIAL CHEMISTRY TESTING KEESLER AFB, MS

Ordering Period 3: 1 Apr 2018 - 31 Mar 2019

AC58 Cost Per Reportable Result RAPID/INTACT PARATHYROID HORMONE (PTH) 1667 $ $

AC59 Cost Per Reportable Result RHEUMATOID FACTOR (RF) 562 $ $

AC60 Cost Per Reportable Result TRIIODOTHYRONINE (FREE T3) 596 $ $

AC61 Cost Per Reportable Result TOTAL TESTOSTERONE 690 $ $

URINE DRUGS OF ABUSE

AC62 Cost Per Reportable Result AMPHETAMINE 832 $ $

AC63 Cost Per Reportable Result BARBITURATE 832 $ $

AC64 Cost Per Reportable Result BENZODIAZEPINE 832 $ $

AC65 Cost Per Reportable Result CANNOBINOID 832 $ $

AC66 Cost Per Reportable Result COCAINE 832 $ $

AC67 Cost Per Reportable Result OPIATE 832 $ $

AC68 Cost Per Reportable Result PHENCYCLIDINE 832 $ $

THERAPEUTIC DRUGS

AC69 Cost Per Reportable Result ACETAMINOPHEN 233 $ $

AC70 Cost Per Reportable Result CARBAMAZEPINE 26 $ $

AC71 Cost Per Reportable Result DIGOXIN 129 $ $

AC72 Cost Per Reportable Result GENTAMICIN 26 $ $

AC73 Cost Per Reportable Result LITHIUM 29 $ $

AC74 Cost Per Reportable Result PHENOBARBITAL 26 $ $

AC75 Cost Per Reportable Result PHENYTOIN 28 $ $

AC76 Cost Per Reportable Result SALICYLATE 217 $ $

AC77 Cost Per Reportable Result THEOPHYLLINE 26 $ $

AC78 Cost Per Reportable Result TOBRAMYCIN 26 $ $

AC79 Cost Per Reportable Result VALPORIC ACID 104 $ $

AC80 Cost Per Reportable Result VANCOMYCIN 427 $ $

URINE CHEMISTRY

AC81 Cost Per Reportable Result URINE/CSF TOTAL PROTEIN 2289 $ $

AC82 Cost Per Reportable Result MICROALBUMIN 12441 $ $

CARDIAC TESTS

AC83 Cost Per Reportable Result C-REACTIVE PROTIEN High Sensitivity 1587 $ $

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ESTIMATED

QUANTITY UNIT PRICE TOTAL PRICE

CHEMISTRY & SPECIAL CHEMISTRY TESTING KEESLER AFB, MS

Ordering Period 3: 1 Apr 2018 - 31 Mar 2019

AC84 Cost Per Reportable Result N TERMINAL-PRO BRAIN NAUTINIC PEPTIDE 2692 $ $

AC85 Cost Per Reportable Result TROPONIN I 4162 $ $

AC86 Cost Per Reportable Result CREATINE KINASE - MUSCLE BRAIN 4047 $ $

703,832

Total Estimated

Price