Attachment_6-Exhibit_AE_Ordering_Period_5.pdf

Exhibit AE FA3010-16-R-0002 Attachment 6

Dated: 20 Oct 2015

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ESTIMATED

QUANTITY UNIT PRICE TOTAL PRICE

GENERAL CHEMISTRY

AE01 Cost Per Reportable Result GLYCOCYLATED HEMAGLOBIN A1C - No Pretreatment Required 14613 $ $

AE02 Cost Per Reportable Result ALBUMIN 32635 $ $

AE03 Cost Per Reportable Result AMMONIA 181 $ $

AE04 Cost Per Reportable Result AMYLASE 595 $ $

AE05 Cost Per Reportable Result ALKALINE PHOSPHATASE 24855 $ $

AE06 Cost Per Reportable Result ALANINE AMINOTRANSFERASE (ALT) 25570 $ $

AE07 Cost Per Reportable Result ASPARTATE AMINOTRANSFERASE (AST) 25854 $ $

AE08 Cost Per Reportable Result BLOOD UREA NITOGEN 44562 $ $

AE09 Cost Per Reportable Result CALCIUM 44867 $ $

AE10 Cost Per Reportable Result CHOLESTEROL 15750 $ $

AE11 Cost Per Reportable Result CREATINE KINASE - TOTAL 4680 $ $

AE12 Cost Per Reportable Result CREATININE 55010 $ $

AE13 Cost Per Reportable Result DIRECT BILIRUBIN 3656 $ $

AE14 Cost Per Reportable Result ALCOHOL 417 $ $

AE15 Cost Per Reportable Result FERRITIN 3442 $ $

AE16 Cost Per Reportable Result GAMMA-GLUTAMYL TRANSFERASE 339 $ $

AE17 Cost Per Reportable Result GLUCOSE 44845 $ $

AE18 Cost Per Reportable Result HIGH DENSITY LYPOPROTIEN - DIRECT 15728 $ $

AE19 Cost Per Reportable Result LOW DENSITY LYPOPROTIEN - DIRECT 15744 $ $

AE20 Cost Per Reportable Result IRON (NO PRETREATMENT) 5068 $ $

AE21 Cost Per Reportable Result LACTATE 1587 $ $

AE22 Cost Per Reportable Result LACTIC DEHYDROGENASE 985 $ $

AE23 Cost Per Reportable Result LIPASE 1841 $ $

AE24 Cost Per Reportable Result MAGNESIUM 7349 $ $

AE25 Cost Per Reportable Result PHOSPHOROUS 10582 $ $

AE26 Cost Per Reportable Result PREALBUMIN 134 $ $

AE27 Cost Per Reportable Result TOTAL BILIRUBIN 25446 $ $

AE28 Cost Per Reportable Result IRON BINDING CAPACITY 5045 $ $

AE29 Cost Per Reportable Result TOTAL PROTEIN 25204 $ $

CHEMISTRY & SPECIAL CHEMISTRY TESTING KEESLER AFB, MS

Ordering Period 5: 1 Apr 2020 - 31 Mar 2021

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ESTIMATED

QUANTITY UNIT PRICE TOTAL PRICE

CHEMISTRY & SPECIAL CHEMISTRY TESTING KEESLER AFB, MS

Ordering Period 5: 1 Apr 2020 - 31 Mar 2021

AE30 Cost Per Reportable Result TRANSFERRIN 5045 $ $

AE31 Cost Per Reportable Result TRIGLYCERIDE 15769 $ $

AE32 Cost Per Reportable Result URIC ACID 1644 $ $

ELECTROLYTES

AE33 Cost Per Reportable Result SODIUM 43477 $ $

AE34 Cost Per Reportable Result POTASSIUM 43460 $ $

AE35 Cost Per Reportable Result CHLORIDE 42997 $ $

AE36 Cost Per Reportable Result CARBON DIOXIDE 41491 $ $

IMMUNOCHEMISTRY

AE37 Cost Per Reportable Result 3RD GENERATION TOTAL PROSTATE SPECIFIC ANTIGEN (PSA) 2696 $ $

AE38 Cost Per Reportable Result 3RD GENERATION THYROID STYMULATING HORMONE (TSH) 14568 $ $

AE39 Cost Per Reportable Result ALPHA FETAL PROTIEN 199 $ $

AE40 Cost Per Reportable Result ANTI STREPTOLYSIN O (ASO) 27 $ $

AE41 Cost Per Reportable Result B12, VITAMIN 3222 $ $

AE42 Cost Per Reportable Result CA-125 ANTIGEN 104 $ $

AE43 Cost Per Reportable Result CARCINOEMBRYONIC ANTIGEN (CEA) 536 $ $

AE44 Cost Per Reportable Result CORTISOL 410 $ $

AE45 Cost Per Reportable Result TOTAL 25-HYDROXYVITAMIN D (TOTAL VITAMIN D) 7036 $ $

AE46 Cost Per Reportable Result ESTRADIOL 231 $ $

AE47 Cost Per Reportable Result FREE PSA 634 $ $

AE48 Cost Per Reportable Result FOLLICLE STIMULATING HORMONE (FSH) 606 $ $

AE49 Cost Per Reportable Result FREE THYROXINE (FT4) 5223 $ $

AE50 Cost Per Reportable Result FOLATE 3222 $ $

AE51 Cost Per Reportable Result Beta HUMAN CHORIONIC GONADOTROPIN (HCG) 876 $ $

AE52 Cost Per Reportable Result IMMUNOGLOBULIN A 303 $ $

AE53 Cost Per Reportable Result IMMUNOGLOBULIN G 303 $ $

AE54 Cost Per Reportable Result IMMUNOGLOBULIN M 303 $ $

AE55 Cost Per Reportable Result LUTEINIZING HORMONE (LH) 606 $ $

AE56 Cost Per Reportable Result PROGESTERONE 129 $ $

AE57 Cost Per Reportable Result PROLACTIN 1178 $ $

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ESTIMATED

QUANTITY UNIT PRICE TOTAL PRICE

CHEMISTRY & SPECIAL CHEMISTRY TESTING KEESLER AFB, MS

Ordering Period 5: 1 Apr 2020 - 31 Mar 2021

AE58 Cost Per Reportable Result RAPID/INTACT PARATHYROID HORMONE (PTH) 1734 $ $

AE59 Cost Per Reportable Result RHEUMATOID FACTOR (RF) 585 $ $

AE60 Cost Per Reportable Result TRIIODOTHYRONINE (FREE T3) 620 $ $

AE61 Cost Per Reportable Result TOTAL TESTOSTERONE 718 $ $

URINE DRUGS OF ABUSE

AE62 Cost Per Reportable Result AMPHETAMINE 866 $ $

AE63 Cost Per Reportable Result BARBITURATE 866 $ $

AE64 Cost Per Reportable Result BENZODIAZEPINE 866 $ $

AE65 Cost Per Reportable Result CANNOBINOID 866 $ $

AE66 Cost Per Reportable Result COCAINE 866 $ $

AE67 Cost Per Reportable Result OPIATE 866 $ $

AE68 Cost Per Reportable Result PHENCYCLIDINE 866 $ $

THERAPEUTIC DRUGS

AE69 Cost Per Reportable Result ACETAMINOPHEN 242 $ $

AE70 Cost Per Reportable Result CARBAMAZEPINE 27 $ $

AE71 Cost Per Reportable Result DIGOXIN 134 $ $

AE72 Cost Per Reportable Result GENTAMICIN 27 $ $

AE73 Cost Per Reportable Result LITHIUM 30 $ $

AE74 Cost Per Reportable Result PHENOBARBITAL 27 $ $

AE75 Cost Per Reportable Result PHENYTOIN 29 $ $

AE76 Cost Per Reportable Result SALICYLATE 226 $ $

AE77 Cost Per Reportable Result THEOPHYLLINE 27 $ $

AE78 Cost Per Reportable Result TOBRAMYCIN 27 $ $

AE79 Cost Per Reportable Result VALPORIC ACID 108 $ $

AE80 Cost Per Reportable Result VANCOMYCIN 444 $ $

URINE CHEMISTRY

AE81 Cost Per Reportable Result URINE/CSF TOTAL PROTEIN 2381 $ $

AE82 Cost Per Reportable Result MICROALBUMIN 12944 $ $

CARDIAC TESTS

AE83 Cost Per Reportable Result C-REACTIVE PROTIEN High Sensitivity 1651 $ $

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ESTIMATED

QUANTITY UNIT PRICE TOTAL PRICE

CHEMISTRY & SPECIAL CHEMISTRY TESTING KEESLER AFB, MS

Ordering Period 5: 1 Apr 2020 - 31 Mar 2021

AE84 Cost Per Reportable Result N TERMINAL-PRO BRAIN NAUTINIC PEPTIDE 2800 $ $

AE85 Cost Per Reportable Result TROPONIN I 4330 $ $

AE86 Cost Per Reportable Result CREATINE KINASE - MUSCLE BRAIN 4211 $ $

732,263

Total Estimated

Price