Y22-115_Exhibit_5_Ryan_White_Part_A_Program_Laboratory_Fees_Schedule.pdf
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- Solicitation number
- Y22-115
- Issued by
- Orange County, Orlando City, Florida
About this file
The document is a Ryan White Part A Program Laboratory Fees Schedule for Orange County, Florida, covering the period from March 1, 2021, to February 28, 2022. This comprehensive fee schedule lists numerous laboratory tests with their corresponding CPT (Current Procedural Terminology) codes and associated rates for various medical diagnostic procedures. The document is part of a solicitation for Outpatient Ambulatory Health Services for Persons with HIV, with sealed offers being accepted until 4:00 pm EST on March 17, 2022, through the OpenGov e-Procurement Platform.
The fee schedule provides a detailed breakdown of laboratory test pricing, ranging from as low as $0.30 for a T3 Uptake test to as high as $292.00 for a Toxoplasma Antibody test. The rates cover a wide range of medical tests, including but not limited to HIV and hepatitis screenings, hormone assays, viral load tests, COVID-19 testing, and various other diagnostic procedures. This pricing schedule is likely part of the Ryan White Part A Program, which provides HIV-related health care and support services to low-income individuals living with HIV/AIDS, ensuring access to critical medical testing and monitoring services.
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Text version
RYAN WHITE PART A PROGRAM LABORATORY FEES SCHEDULE
March 1, 2021 - February 28, 2022
CPT Code DESCRIPTION
RATE FOR
36415L DRAW FEE PSC SPEC 4.00$
80053 COMPREHENSIVE METABOLIC PANEL 1.51$
80061 LIPID PANEL, STANDARD 1.75$
80074 HEPATITIS PANEL 18.00$
80076 HEPATIC FUNCTION PANEL 10256 1.16$
80164 VALPORIC ACID 30.10$
80307 DAP 10-50 11.40$
80320 ALCOHOL, ETHYL 20.00$
80349 MARIJUANA QL CONF 96.45$
81001 URINALYSIS COMPLETE 1.50$
81003L URINALYSIS SCREEN 0.69$
81015 RFL-MICR (INC) 0.81$
81381 HLA-B * 5701 TYPING 45.00$
81596 LIVER FIBROSIS 125.00$
82043 MICROALBUMIN RANDOM URINE 4.90$
82105 MATERNAL SERUM AFP 50.88$
82150 AMYLASE 24.16$
82274 FECAL IMMUNOCHEM 11.00$
82306 VITAMIN D 25 HYDROXY TOTAL IMMUNOASSAY 8.00$
82465 CHOLESTEROL TOTAL 0.59$
82550 CK, TOTAL 27.20$
82550B CK, TOTAL 27.74$
82570 CREATININE RAND (U) 1.06$
82607 VITAMIN B12 3.00$
82652 VITAMIN D 75.10$
82670 ESTRADIOL 33.00$
82728 FERRITIN 4.00$
82746 FOLATE SERUM 3.00$
82955 GLUCOSE-6-PHOSPHATE DEHYDROGENASE, QUANTITATIVE 31.55$
82977 GCT 24.60$
83001 LAB FOLLICLE STIMULATING HORMONE (FSH) SERUM 3.50$
83002 LAB LUTEINIZING HORMONE (LH) S 3.50$
83021 HEMOGOBINOPATHY 6.00$
83036 HEMOGLOBIN A1C 2.00$
83540 IRON TOTAL 2.32$
83550 IRON TOTAL AND IRON BINDING CAPACITY 4.50$
83615 LDH TOTAL 24.00$
83690 LIPASE 35.88$
83718 HDL CHOLESTEROL 0.58$
83721 Direct LDL 24.75$
83735 MAGNESIUM 6.00$
83970 PTH INTACT AND CALCIUM 120.00$
84100 PHOSPHATE 0.88$
84146 PROLACTIN 7.00$
CPT Code DESCRIPTION
RATE FOR
84153 PSA TOTAL 3.50$
84153B QST PSA TOTAL 4.20$
84270 ASSAY OF HORMONE 78.58$
84402 TESTOSTERONE FREE 178.00$
84402B ASSAY OF TESTOSTERONE 138.00$
84403 TESTOSTERONE MALE MALE ADULT IMMUNOASSAY 6.00$
84436 T-4 THYROXINE 0.80$
84439 T-4 FREE 5.00$
84443 TSH 2.00$
84450 AST 0.88$
84460 LAB ALANINE AMINOTRANSFERASE (ALT) 0.88$
84478 TRIGLYCERIDES 0.58$
84479 T3 UPTAKE 0.30$
84480 T-3 Total 72.00$
84481 T-3 FREE 18.88$
84550 URIC ACID 0.88$
85025 COMPLETE CBC W/AUTO DIFF WBC 1.10$
85041 CBC (DIFF PLT) 0.85$
85045 RETICULOCYTE COUNT 8.00$
85610 PROTHROMBIN TIME WITH INR 2.50$
85652 SEDIMENTATION RATE WESTERGR 2.00$
85730 PTT Activated 1.00$
86317 HEP B SURFACE AB QN 3.16$
86360 LYMPHOCYTE SUBSET PANEL 4 / CD4 CD8 13.00$
86361 LYMPH SUBSET PNL 5 14.00$
86480 QUANTIFERON ( R ) PL 1T 25.00$
86592 RPR (DX) REFL FTA 2.00$
86593 RPR TITER 1.06$
86644 CMV IGG AB 56.88$
86645 CMV IGM AB 71.36$
86682 HELMINTH ANTIBODY/ STRONGYLOIDES IGG AB 20.65$
86695 HSV 1 IGG 2.50$
86695B HSV 1/2 IGG TYPE SP 5.00$
86696 HSV 2 IGG 2.50$
86701 HIV 1 AND 2 AB DIFF 25.00$
86702 HIV 1 AND 2 AB DIFF 25.00$
86704 HEP B CORE AB TOTAL 4.70$
86705 HEP B CORE IGM AB 7.15$
86706 HEP B SURF AB QL 2.80$
86707 HEP BE AB 51.20$
86708 HEP A AB TOTAL 2.80$
86709 HEP A IGM AB 6.99$
86735 MUMPS VIRUS IGG, EIA 13.50$
86762 RUBELLA IMMUNE 0.90$
CPT Code DESCRIPTION
RATE FOR
86765 MEASLES AB IGG, EIA 50.00$
86769 Post Vaccination COVID Antibody Test/Post Exposure 50.00$
86777 TOXOPLASMA ANTIBODY (IgG) 8.00$
86777B TOXOPLASMA ANTIBODY 85.60$
86777C TOXOPLASMA ANTIBODY 292.00$
86778 TOXOPLASMOSIS IGM EIA 44.80$
86780 TREPONEMA PALLIDUM ANTIBODY, PARTICLE AGGLUTINATION 25.96$
86803 HEP C AB WITH REFL HCV 2.80$
87045 SALMONELLA/SHINGELLA CULTURE 1.68$
87070 CULTURE AEROBIC BACTERIA 6.00$
87086 CULTURE URINE ROUTINE 3.00$
87147 ORG ID 1 4.00$
87186 SUSC 1 4.00$
87209 OVA AND PARASITE 5.00$
87329 GIARDIA AG W/ RFL 60.25$
87340 HEPATITIS B SURFACE ANTIGEN WITH REFLEX CONFIRMATION 4.25$
87350 HEP BE AG 51.20$
87389 HIV 1/2 ANTIGEN AND ANTIBODIES FOURTH GENERATION WITH REFLEX 6.80$
87426 COVID Antigen by Swab 35.33$
87491 C. TRACH RNA, TMA, THROAT 6.00$
87491B CHYLMD TRACH DNA AMP PROBE 12.00$
87517 HBV DNA QT PCR RFX 45.00$
87521 HCV RNA, QL TMA/ HEPATITIS C RNA AMP PROBE 221.00$
87522 HEPATITIS C VIRAL RNA, QUANTITATIVE 45.00$
87536 HIV-1 RNA, QUANTITATIVE, REAL-TIME PCR 44.50$
87591 N. GON RNA, TMA, THROAT/ N. GON DNA AMP PROBE 6.00$
87624 HPV RNA HR E6 E7 TMA 18.00$
87625 HPV GENO 16, 18/45 36.00$
87635 COVID-19 TESTING 119.00$
87661 T. VAGINALIS RNA, MALE 18.00$
87900 HIV 1 GENOTYPE 95.10$
87901 GENOTYPE TM MG 95.10$
87902 HCV GENOTYPE LIPA ( R ) 140.00$
87906 HIV 1 INTEGRASE 95.10$
88112 CYTOLOGY NON GYNECOLOGICAL FLUID, WASHINGS, BRUSHINGS OR FNA 108.38$
88141 PATH REVIEW LIQUID PAP 5.00$
88142 THINPREP, HPV 18.00$
88142B CYTOPATH C/V THIN LAYER 12.60$
88174 SUREPATH FPGS PAP RFX HPV 18811 16.54$
88175 CYTYC PAP & RVW 19.69$
88175B CYTYC PAP & RVW 15.75$
88305 BM INTERP CLOT CELL BX 81.50$
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