The file's text, extracted by GovTribe without its formatting.
Attachment A: Required Testing and Volume Note: All quantities are estimates per contract period
| CPT |
| TEST |
| ESTIMATED VOLUME |
| 80048 |
| BASIC METABOLIC PANEL |
| 10 |
| EA |
| 80061 |
| LIPID PROFILE |
| 10 |
| EA |
| 80074 |
| ACUTE HEPATITIS PANEL |
| 10 |
| EA |
| 80156 |
| CARBAMAZEPINE (TEGRETOL) |
| 10 |
| EA |
| 80162 |
| DIGOXIN (LANOXIN) |
| 10 |
| EA |
| 80164 |
| DIPROPYLACETIC ACID(VALPROIC) |
| 10 |
| EA |
| 80184 |
| PHENOBARBITAL |
| 10 |
| EA |
| 80202 |
| VANCOMYCIN PEAK/TROUGH |
| 10 |
| EA |
| 80306 |
| TOXI SCREENURINE |
| 10 |
| EA |
| 81001 |
| URINALYSIS AUTO W/ MICRO |
| 10 |
| EA |
| 82010 |
| ACETONE/KETONES SERUM QN |
| 10 |
| EA |
| 82040 |
| ALBUMIN SERUM QN |
| 10 |
| EA |
| 82042 |
| ALBUMIN URINE OR OTHER SOURCE |
| 10 |
| EA |
| 82247 |
| BILIRUBIN TOTAL |
| 10 |
| EA |
| 82330 |
| CALCIUM IONIZED |
| 10 |
| EA |
| 82553 |
| CREATINE KINASE (CPK) MB ONLY |
| 10 |
| EA |
| 82945 |
| GLUCOSE BODY FLUID |
| 10 |
| EA |
| 82947 |
| GLUCOSE BLOOD QN |
| 10 |
| EA |
| 83036 |
| HEMOGLOBIN GLYCOSYLATED |
| 10 |
| EA |
| 83615 |
| LACTATE DEHYDROGENASE (LDH) |
| 10 |
| EA |
| 83880 |
| IMMUNOASSAY BNP |
| 10 |
| EA |
| 83880 |
| IMMUNOASSAY BNP I-STAT |
| 10 |
| EA |
| 83930 |
| OSMOLALITY BLD |
| 10 |
| EA |
| 83935 |
| OSMOLALITY URINE |
| 10 |
| EA |
| 84145 |
| PROCALCITONIN (PCT) |
| 10 |
| EA |
| 84155 |
| PROTEIN SERUM |
| 10 |
| EA |
| 84156 |
| PROTEIN URINE |
| 10 |
| EA |
| 84157 |
| TOTAL PROTEIN BODY FLUID |
| 10 |
| EA |
| 84484 |
| TROPONIN I QN |
| 10 |
| EA |
| 84484 |
| TROPONIN I QN I-STAT |
| 10 |
| EA |
| 85014 |
| HEMATOCRIT NON-SPUN |
| 10 |
| EA |
| 85025 |
| CBC AUTO W/AUTO DIFF |
| 10 |
| EA |
| 85027 |
| CBC AUTO W/O DIFF |
| 10 |
| EA |
| 85045 |
| BLD CNT RETICULOCYTE AUTO |
| 10 |
| EA |
| 85362 |
| FDP/FSP AGGLUTINATION SQ |
| 10 |
| EA |
| 85379 |
| FIBRIN DEGRADATION D-DIMER QN |
| 10 |
| EA |
| 85576 |
| PLATELET AGGREGATION |
| 10 |
| EA |
| 85610 |
| PROTHROMBIN TIME (PT) |
| 10 |
| EA |
| 86022 |
| AB ID PLATELET |
| 10 |
| EA |
| 86023 |
| AB ID PLATELET ASSOC IGG |
| 10 |
| EA |
| 86308 |
| AB HETEROPHILE SCREEN |
| 10 |
| EA |
| 86403 |
| PARTICLE AGGLUT SCREEN |
| 10 |
| EA |
| 86677 |
| AB HELICOBACTER PYLORI |
| 10 |
| EA |
| 86706 |
| AB HEP B SURFACE (HBSAB) |
| 10 |
| EA |
| 86709 |
| AB HEP A (HAAB) IGM |
| 10 |
| EA |
| 87071 |
| CULTURE AEROBIC OTHER QN |
| 10 |
| EA |
| 87071 |
| MULT CULTURE AEROBIC OTHER QN |
| 10 |
| EA |
| 87077 |
| AER ORGANISM ID EA ISOLATE |
| 10 |
| EA |
| 87149 |
| CULTURE TYPING ID NA |
| 10 |
| EA |
| 87207 |
| SMEAR MALARIA |
| 10 |
| EA |
| 87328 |
| AG EIA QL CRYPTOSPORIDIUM |
| 10 |
| EA |
| 87329 |
| AG EIA QL GIARDIA |
| 10 |
| EA |
| 87338 |
| H PYLORI AG EIA STOOL |
| 10 |
| EA |
| 87340 |
| AG EIA QL HEP B AG (HBSAG) |
| 10 |
| EA |
| 87491 |
| NUC ACID PROBE AMP CHLAMYD T |
| 10 |
| EA |
| 87493 |
| NUC ACID PROBE AMP C DIFF |
| 10 |
| EA |
| 87506 |
| STOOL PATHOGEN PANEL |
| 10 |
| EA |
| 87798 |
| NUC ACID PROBE AMP INFECTIOUS |
| 10 |
| EA |
| 87798 |
| REF NUC ACID PROBE AMP INFECTIOUS |
| 10 |
| EA |
| 87798 |
| REF2 NUC ACID PROBE AMP INFECTIOUS |
| 10 |
| EA |
| 87802 |
| IMMUNO OPTICAL STREP GROUP B |
| 10 |
| EA |
| 87804 |
| INF AGNT BY IA INFLUENZA |
| 10 |
| EA |
| 87899 |
| INF AGENT AG DETECT IA/OPTC SCREEN NOC |
| 10 |
| EA |
| 89321 |
| SEMEN ANALYSIS |
| 10 |
| EA |
| G0480 |
| DRUG TEST DEF 1-7 CLASSES |
| 10 |
| EA |
| XXXXX |
| Other Tests as Needed (On Compendium) |
| 1 |
| N/A |