Attachment_5-Exhibit_AD_Ordering_Period_4.pdf

Exhibit AD FA3010-16-R-0002 Attachment 5

Dated: 20 Oct 2015

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ESTIMATED

QUANTITY UNIT PRICE TOTAL PRICE

GENERAL CHEMISTRY

AD01 Cost Per Reportable Result GLYCOCYLATED HEMAGLOBIN A1C - No Pretreatment Required 14326 $ $

AD02 Cost Per Reportable Result ALBUMIN 31995 $ $

AD03 Cost Per Reportable Result AMMONIA 177 $ $

AD04 Cost Per Reportable Result AMYLASE 584 $ $

AD05 Cost Per Reportable Result ALKALINE PHOSPHATASE 24367 $ $

AD06 Cost Per Reportable Result ALANINE AMINOTRANSFERASE (ALT) 25069 $ $

AD07 Cost Per Reportable Result ASPARTATE AMINOTRANSFERASE (AST) 25347 $ $

AD08 Cost Per Reportable Result BLOOD UREA NITOGEN 43688 $ $

AD09 Cost Per Reportable Result CALCIUM 43987 $ $

AD10 Cost Per Reportable Result CHOLESTEROL 15442 $ $

AD11 Cost Per Reportable Result CREATINE KINASE - TOTAL 4589 $ $

AD12 Cost Per Reportable Result CREATININE 53932 $ $

AD13 Cost Per Reportable Result DIRECT BILIRUBIN 3585 $ $

AD14 Cost Per Reportable Result ALCOHOL 409 $ $

AD15 Cost Per Reportable Result FERRITIN 3375 $ $

AD16 Cost Per Reportable Result GAMMA-GLUTAMYL TRANSFERASE 332 $ $

AD17 Cost Per Reportable Result GLUCOSE 43966 $ $

AD18 Cost Per Reportable Result HIGH DENSITY LYPOPROTIEN - DIRECT 15419 $ $

AD19 Cost Per Reportable Result LOW DENSITY LYPOPROTIEN - DIRECT 15435 $ $

AD20 Cost Per Reportable Result IRON (NO PRETREATMENT) 4969 $ $

AD21 Cost Per Reportable Result LACTATE 1556 $ $

AD22 Cost Per Reportable Result LACTIC DEHYDROGENASE 966 $ $

AD23 Cost Per Reportable Result LIPASE 1805 $ $

AD24 Cost Per Reportable Result MAGNESIUM 7205 $ $

AD25 Cost Per Reportable Result PHOSPHOROUS 10374 $ $

AD26 Cost Per Reportable Result PREALBUMIN 132 $ $

AD27 Cost Per Reportable Result TOTAL BILIRUBIN 24947 $ $

AD28 Cost Per Reportable Result IRON BINDING CAPACITY 4946 $ $

AD29 Cost Per Reportable Result TOTAL PROTEIN 24710 $ $

CHEMISTRY & SPECIAL CHEMISTRY TESTING KEESLER AFB, MS

Ordering Period 4: 1 Apr 2019 - 31 Mar 2020

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ESTIMATED

QUANTITY UNIT PRICE TOTAL PRICE

CHEMISTRY & SPECIAL CHEMISTRY TESTING KEESLER AFB, MS

Ordering Period 4: 1 Apr 2019 - 31 Mar 2020

AD30 Cost Per Reportable Result TRANSFERRIN 4946 $ $

AD31 Cost Per Reportable Result TRIGLYCERIDE 15460 $ $

AD32 Cost Per Reportable Result URIC ACID 1612 $ $

ELECTROLYTES

AD33 Cost Per Reportable Result SODIUM 42624 $ $

AD34 Cost Per Reportable Result POTASSIUM 42608 $ $

AD35 Cost Per Reportable Result CHLORIDE 42154 $ $

AD36 Cost Per Reportable Result CARBON DIOXIDE 40677 $ $

IMMUNOCHEMISTRY

AD37 Cost Per Reportable Result 3RD GENERATION TOTAL PROSTATE SPECIFIC ANTIGEN (PSA) 2643 $ $

AD38 Cost Per Reportable Result 3RD GENERATION THYROID STYMULATING HORMONE (TSH) 14283 $ $

AD39 Cost Per Reportable Result ALPHA FETAL PROTIEN 195 $ $

AD40 Cost Per Reportable Result ANTI STREPTOLYSIN O (ASO) 27 $ $

AD41 Cost Per Reportable Result B12, VITAMIN 3159 $ $

AD42 Cost Per Reportable Result CA-125 ANTIGEN 102 $ $

AD43 Cost Per Reportable Result CARCINOEMBRYONIC ANTIGEN (CEA) 525 $ $

AD44 Cost Per Reportable Result CORTISOL 402 $ $

AD45 Cost Per Reportable Result TOTAL 25-HYDROXYVITAMIN D (TOTAL VITAMIN D) 6898 $ $

AD46 Cost Per Reportable Result ESTRADIOL 226 $ $

AD47 Cost Per Reportable Result FREE PSA 622 $ $

AD48 Cost Per Reportable Result FOLLICLE STIMULATING HORMONE (FSH) 594 $ $

AD49 Cost Per Reportable Result FREE THYROXINE (FT4) 5120 $ $

AD50 Cost Per Reportable Result FOLATE 3159 $ $

AD51 Cost Per Reportable Result Beta HUMAN CHORIONIC GONADOTROPIN (HCG) 859 $ $

AD52 Cost Per Reportable Result IMMUNOGLOBULIN A 297 $ $

AD53 Cost Per Reportable Result IMMUNOGLOBULIN G 297 $ $

AD54 Cost Per Reportable Result IMMUNOGLOBULIN M 297 $ $

AD55 Cost Per Reportable Result LUTEINIZING HORMONE (LH) 594 $ $

AD56 Cost Per Reportable Result PROGESTERONE 126 $ $

AD57 Cost Per Reportable Result PROLACTIN 1155 $ $

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ESTIMATED

QUANTITY UNIT PRICE TOTAL PRICE

CHEMISTRY & SPECIAL CHEMISTRY TESTING KEESLER AFB, MS

Ordering Period 4: 1 Apr 2019 - 31 Mar 2020

AD58 Cost Per Reportable Result RAPID/INTACT PARATHYROID HORMONE (PTH) 1700 $ $

AD59 Cost Per Reportable Result RHEUMATOID FACTOR (RF) 573 $ $

AD60 Cost Per Reportable Result TRIIODOTHYRONINE (FREE T3) 608 $ $

AD61 Cost Per Reportable Result TOTAL TESTOSTERONE 704 $ $

URINE DRUGS OF ABUSE

AD62 Cost Per Reportable Result AMPHETAMINE 849 $ $

AD63 Cost Per Reportable Result BARBITURATE 849 $ $

AD64 Cost Per Reportable Result BENZODIAZEPINE 849 $ $

AD65 Cost Per Reportable Result CANNOBINOID 849 $ $

AD66 Cost Per Reportable Result COCAINE 849 $ $

AD67 Cost Per Reportable Result OPIATE 849 $ $

AD68 Cost Per Reportable Result PHENCYCLIDINE 849 $ $

THERAPEUTIC DRUGS

AD69 Cost Per Reportable Result ACETAMINOPHEN 238 $ $

AD70 Cost Per Reportable Result CARBAMAZEPINE 27 $ $

AD71 Cost Per Reportable Result DIGOXIN 132 $ $

AD72 Cost Per Reportable Result GENTAMICIN 27 $ $

AD73 Cost Per Reportable Result LITHIUM 30 $ $

AD74 Cost Per Reportable Result PHENOBARBITAL 27 $ $

AD75 Cost Per Reportable Result PHENYTOIN 29 $ $

AD76 Cost Per Reportable Result SALICYLATE 222 $ $

AD77 Cost Per Reportable Result THEOPHYLLINE 27 $ $

AD78 Cost Per Reportable Result TOBRAMYCIN 27 $ $

AD79 Cost Per Reportable Result VALPORIC ACID 106 $ $

AD80 Cost Per Reportable Result VANCOMYCIN 435 $ $

URINE CHEMISTRY

AD81 Cost Per Reportable Result URINE/CSF TOTAL PROTEIN 2335 $ $

AD82 Cost Per Reportable Result MICROALBUMIN 12690 $ $

CARDIAC TESTS

AD83 Cost Per Reportable Result C-REACTIVE PROTIEN High Sensitivity 1618 $ $

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ESTIMATED

QUANTITY UNIT PRICE TOTAL PRICE

CHEMISTRY & SPECIAL CHEMISTRY TESTING KEESLER AFB, MS

Ordering Period 4: 1 Apr 2019 - 31 Mar 2020

AD84 Cost Per Reportable Result N TERMINAL-PRO BRAIN NAUTINIC PEPTIDE 2745 $ $

AD85 Cost Per Reportable Result TROPONIN I 4245 $ $

AD86 Cost Per Reportable Result CREATINE KINASE - MUSCLE BRAIN 4128 $ $

717,911

Total Estimated

Price