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HomeMy WebLinkAbout32543 COUNTY OF FRESNO Fresno, CA - 1 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 AMENDMENT I TO AGREEMENT THIS AMENDMENT, hereinafter referred to as “Amendment I”, is made and entered into this ____ day of __________, 2016, by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to as “COUNTY”, and UNILAB CORPORATION dba QUEST DIAGNOSTICS, a California Corporation, whose address is 3714 Northgate Boulevard, Sacramento, California 94834, hereinafter referred to as “CONTRACTOR” (collectively the “parties”). WHEREAS, the parties entered into that certain Agreement, identified as COUNTY Agreement No. A-15-523, effective July 1, 2015, hereinafter referred to as “Agreement”, whereby CONTRACTOR agreed to provide certain clinical laboratory and toxicology testing services including, but not limited to, supplies for specimen collections, phlebotomy services, specimen pick- up and delivery, laboratory testing, critical value reporting, and routing laboratory orders for health programs for COUNTY’s consumers and clients; and WHEREAS, the parties now desire to amend the Agreement regarding changes as stated below and restate the Agreement in its entirety. NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions, hereinafter set forth, the sufficiency of which is hereby acknowledged, the parties agree as follows: 1. That all references in the existing COUNTY Agreement No. 15-523 to “Exhibit A” be changed to read “Revised Exhibit A”, where appropriate, attached hereto and incorporated by reference. 2. That all references in the existing COUNTY Agreement No. 15-523 to “Exhibit C” be changed to read “Revised Exhibit C”, where appropriate, attached hereto and incorporated by reference. 3. That all references in the existing COUNTY Agreement No. 15-523 to “Exhibit D” be changed to read “Revised Exhibit D”, where appropriate, attached hereto and incorporated by reference. 4. That the existing COUNTY Agreement No. 15-523, Page Five (5), beginning with Line Four (4), with the word “In” and ending on Page Five (5), Line Nine (9) with the number COUNTY OF FRESNO Fresno, CA - 2 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 “($4,550.00)” be deleted and the following inserted in its place: “In addition, CONTRACTOR shall provide one (1) phlebotomist, up to three (3) days a week each for up to three and one half (3.5) hours at DBH’s Metro Outpatient Services located at 4441 E. Kings Canyon Road, Fresno, CA 93702. COUNTY’s DBH shall pay CONTRACTOR Twenty Five and 00/100 Dollars ($25.00) for each hour or proration thereof worked by the phlebotomist. The maximum compensation for phlebotomist services under this Agreement shall not be in excess of Thirteen Thousand Six Hundred Fifty and 00/100 Dollars ($13,650.00).” 5. That the existing COUNTY Agreement No. 15-523, Page Eight (8), beginning with Line Twenty Six (26), with the word “Minor” and ending on Page Eight (8), Line Twenty-Eight (28) with the word “sent” be deleted and the following inserted in its place: “Minor changes may include the addition of clinical laboratory and toxicology tests and changes in the unit price of clinical laboratory and toxicology tests to reflect pricing guidelines not to exceed 10% of the listed unit price.” 6. COUNTY and CONTRACTOR agree that this Amendment I is sufficient to amend the Agreement; and that upon execution of this Amendment I, the Agreement and Amendment I together shall be considered the Agreement. 7. Except as otherwise provided in this Amendment I, all other provisions of the Agreement remain unchanged and in full force and effect. This Amendment I shall become effective retroactive to July 1, 2015. /// /// /// /// /// /// /// /// /// 1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment I to Agreement 2 No. 15.523 as of the day and year first hereinabove written. 3 4 CONTRACTOR: UNILAB CORPORATION 5 dba Q:tJEST DIAGNoscqcs 8 6./-.• ' / By -: ... -==-~==<E31SJ~9~0---~~~=====s~--~~::-- 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Print Name: Rob Moverley Title: Vice President & General Manager Date: 4.6.16 By ______________________ __ Print Name:------------- Title:------------- Dme: ________ __ Mailing Address: 7060 N. Recreation, Suite 106 Fresno, CA 93720 Phone#: (559) 225-1611, ext. 475 Contact: Lois Phelps, District Sales Manager -3 - COUNTY OF FRESNO: By~~ Chairman, Board of Supervisors Date: A FJLrl c1LP, ~/01 BERNICE E. SEIDEL, Clerk Board of Supervisors By~ ~sho--p,~ Date: A pit \ Bl.a , fUJ /{ o PLEASE SEE ADDITIONAL SIGNATURE PAGE ATTACHED COUNTY OF FRESNO Fresno, CA Revised Exhibit A Page 1 of 8 SCOPE OF WORK GROUPS I AND II DEPARTMENTS OF PUBLIC HEALTH AND BEHAVIORAL HEALTH SERVICE REQUIREMENTS The Contractor will be responsible for providing all needed supplies for specimen collection, collecting and picking up from the various sites. Services include, but are not limited to, supplies for specimen collections, phlebotomy services, specimen pick-up and delivery, laboratory testing, critical value reporting and timely response for STAT and routine laboratory orders. These services will be required for the operation of County of Fresno and metropolitan Fresno-Clovis sites as outlined below. Contractor will provide all laboratory services and necessary supplies. Contractor must be CLIA (Clinical Laboratory Improvement Amendments) certified. Laboratory services will be provided in response to telephone or fax requests from authorized nursing or clerical staff acting as agents of assigned licensed physicians or from requests ordered through the computer system. 1. All Services will be provided in accordance with Fresno County, State and Federal client/consumer confidentiality requirements. 2. Blood draws/specimen collection will be performed by the Contractor. Occasionally, County staff will do the collection, as deemed necessary, by County staff ordering the testing. Contractor will provide a lab book to DBH outlining specific procedures for specimen collection that are necessary for processing/testing, such as collection requirements, storage requirements, minimum volumes, etc. 3. The Contractor will provide blood draw services up to 3 days each week for a period of up to 3.5 hours at the DBH Metro Outpatient site located at 4441 E. Kings Canyon Road, Fresno, CA 93702. The specific days and time period of services needed currently and for future needs will be determined by the DBH Medical Director, or designee. 4. A list of available testing/collection sites and hours of operation within Fresno County shall be submitted by Contractor. 5. All STAT services will be provided 7 days per week, 24 hours per day at designated DBH facilities. All specimen pick-ups, where necessary, will be performed by the Contractor. STAT response time will be within one hour of receipt of request. DBH have approximately 10 STAT requests per year. Revised Exhibit A Page 2 of 8 6. Reporting of Critical Test Values shall be completed within 30 minutes after verification and ordering physician will be called with name, date and time of specimen collection, along with test results, as well as patient’s/client’s DOB (Date of Birth) when necessary. Reporting of Critical Test Values ordered during regular business hours (Monday through Friday 8:00 am – 5:00 pm) for DBH shall be provided to the Metro Outpatient nurses with name, date and time of specimen collection, and test results, as well as patient’s/client’s DOB (Date of Birth) when necessary. Reporting for Critical Test Values ordered outside regular business hours for DBH shall be provided directly to the DBH Medical Director with name, date and time of specimen collection, and test results, as well as patient’s/client’s DOB (Date of Birth) when necessary. Critical Test Value reporting is rare for DBH and DPH. Critical Test Values also known as “critical values” and “critical results” are test results that fall significantly outside the normal range and may represent life-threatening values even if from routine tests. 7. Billings for services will be submitted on a monthly invoice statement and are to be listed by Department and cost center, listing the full name of the patient/client, date of birth, Fresno County Medical Record Number, date of service and name of laboratory test. Payments may be delayed if invoices are incomplete or incorrect. Invoices are to be sent to: Department of Public Health (DPH) P.O. Box 11867 Fresno, CA 93775 Department of Behavioral Health (DBH) P.O. Box 45003, Fresno, CA 93718 8. Billing Discrepancies: The County prefers the Contractor provide one contact person to address billing questions and discrepancies for DPH and DBH. The Contractor is to respond to inquiries in a timely manner –within 7 business days. 9. The Contractor will be required to assume full responsibility for all services and activities offered in the quotation and resulting Agreement, with the exception of services and activities provided by the County of Fresno whether or not they are provided directly. The County of Fresno will consider the Contractor to be the sole point of contact with regard to contractual matters, including payment of any and all charges resulting from the contract. The contractor may not subcontract or transfer the contract, or any right or obligation arising out of the contract, without first having obtained the express written consent of the County. 10. Public Health requires a daily 4:30 pm specimen pick-up. All DPH specimens are to be picked up in the TB Clinic. Located at 1221 Fulton Mall, First Floor, Fresno, CA 93775. 11. Specimen pick-up for DBH facilities shall be no later than 4:00 pm 12. The Contractor shall be responsible for billing Medi-Cal for Medi-Cal eligible clients as well as other applicable third party insurances. The Contractor shall Revised Exhibit A Page 3 of 8 collect necessary information pertinent to billing Medi-Cal and third party insurances from clients. DBH reports that currently approximately 45% of their outpatient billings are Medi-Cal. These Medi-Cal percentages could change if the department can see only Medi-Cal recipients. Approximately 46% of the clients DPH treats are Medi-Cal or Medi-Cal eligible, or have other third party insurance. 13. The Contractor shall provide online access to printable test results, requests and lab results twenty four hours (24) per day 365 days per year. 14. The Contractor shall provide online access of lab results to medical staff and these results must be printable. Common tests, such as CBCs, will be available online within 24 hours of collection. Specialty tests such as Medication level and Hep-C tests will be available online within 5 days. 15. The County requires at least 60 days’ prior notice, or reasonable notice, of any and all system changes that impact portal access, invoicing and requisition forms. The notice should include what change is taking place, when it is happening, what is causing the change, what will be impacted (i.e., internet access, account numbers, test codes, etc.) and how it will be implemented. If the changes will impact existing account numbers, the Contractor will provide detailed steps that will be taken to avoid duplicate billing. Revised Exhibit A Page 4 of 8 SCOPE OF WORK GROUP I DEPARTMENT OF PUBLIC HEALTH TYPES OF REQUIRED CLINICAL LABORATORY TESTS The average volume of clinical laboratory tests that the Public Health Department conducted in the past year are provided in the Quotation Schedule. While every effort was made to get the most current information on the types of tests needed by each program, the types of tests listed below are best estimates only. The County does not guarantee any minimums for any of the tests listed below. Program Types of Tests County Laboratory Majority of tests are T-Lymphocyte Helper CD Panels and miscellaneous other tests Chest Clinic Tests include Coccidiodal Serology Panels, liver function panels, TSH and miscellaneous other tests HIV Prevention Testing HIV Screening, HIV-1/2 Antigens and Antibodies (CPT Code 91431), HIV-1/2 Antibody- HIV- Differentiation (CPT Code 91432), and HIV-1 RNA comprise the bulk of testing in this area. Court Ordered HIV Testing Approximately 30 individuals undergo HIV Screening tests annually Revised Exhibit A Page 5 of 8 SCOPE OF WORK GROUP I DEPARTMENT OF PUBLIC HEALTH LABORATORY SERVICES FOR FACILITIES THAT OPERATE MONDAY THROUGH FRIDAY, 8:00 A.M. TO 5:00 P.M. Please note that Billing/Cost Center numbers listed at the end of each program below are for internal use only and vendors responding to RFQ are not required to include this information in their quotation. 1. Chest Clinic, 1221 Fulton Mall, Fresno, CA 93775, phone: (559) 600-3413. (BILLING/COST CENTER #56201650) The Chest Clinic provides services for the detection, prevention and treatment of TB, specifically, skin testing, chest X-rays, prevention treatment, and diagnosis of an active disease. The clinic also operates a Directly Observed Therapy outreach unit which monitors and ensures patient compliance with the prescribed treatment plan. The state and federal government have established priorities and objectives which are designed to address the highest priorities in TB control: (1) The first priority is to identify persons who have active TB cases and ensure that they complete appropriate therapy, including using confinement measures in exceptional cases; (2) The second priority is to find and screen persons who have been in contact with TB clients to determine whether they have TB infection or disease and provide them with appropriate treatment. (3) The third is to screen high-risk populations to detect persons who are identified with Multiple Drug Resistant TB. 2. Drug Alcohol Testing, 1221 Fulton Mall, Fresno, CA 93775, phone: (559) 600- 3434. [BILLING/COST CENTER # 56201639)] HIV counseling and screening services are provided to individuals who are currently participating in drug/alcohol treatment programs, both residential as well as outpatient programs. The program is supported through an interagency agreement with the Substance Abuse Division. In addition to counseling and testing services, group education is provided to clients as well as regular program updates with the staff of participating programs. 3. HIV Prevention Testing, 1221 Fulton Mall, Fresno, CA 93775, phone: (559) 600- 3434 (BILLING/COST CENTER #56201645) Revised Exhibit A Page 6 of 8 HIV counseling and screening services are provided to individuals who demonstrate an increased risk for HIV transmission. This program is supported through a grant from the California Department of Public Health. 4. Court Ordered HIV Testing, 1221 Fulton Mall, Fresno, CA 93775, phone: (559) 600-3434, (BILLING/COST #56201648) Court ordered HIV counseling and screening is provided to individuals who have been ordered by the court to complete HIV education and testing, under Penal Code 1202.1. Revised Exhibit A Page 7 of 8 SCOPE OF WORK GROUP II DEPARTMENT OF BEHAVIORAL HEALTH TYPES OF REQUIRED CLINICAL LABORATORY TESTS The average volume of clinical laboratory tests the Behavioral Health Department conducted in the past year are provided for the programs with the highest utilization. While every effort was made to get the most current information on the types of tests needed by each program, the types of tests listed below are best estimates only. The County does not guarantee any minimums for any of the tests listed below. Program Types of Tests Metro Outpatient Services Majority of tests are CBC differential, mostly for Clozaril monitoring (30%) and Blood Drawing (15%). Other tests include TSH, Comprehensive Metabolic Panel, Valproic Acid, Lipid Profile, Lithium, Hepatic Function Panel, Glucose Plasma, Triglycerides, AST, Glucose Random, Prolactin, Urine Toxicology, Hemoglobin A1C Immunoassay, EtOH serum, Drug Abuse Panel 9 Serum, and miscellaneous other tests. Pathways to Recovery Tests include, but are not limited to, Urine Toxicology and miscellaneous other tests. Older Adult Mental Health Clinic Tests include, but are not limited to, Comprehensive Metabolic Panel, CBC differential, Lipid Panel, Hemoglobin A1C Immunoassay, TSH, Urinalysis Reflex, Valporic Acid, etc. Revised Exhibit A Page 8 of 8 SCOPE OF WORK GROUP II DEPARTMENT OF BEHAVIORAL HEALTH LABORATORY SERVICES FOR FACILITIES THAT OPERATE MONDAY THROUGH FRIDAY, 8:00 A.M. TO 5:00 P.M. Please note that Billing/Cost Center numbers listed at the end of each program below are for internal use only. DBH facilities and programs that require Contractor’s services include, but are not limited, to the following: 1. Metro Outpatient Services, 4441 E. Kings Canyon Road, Fresno, CA 93702, phone (559) 600-4099, fax (559) 600-9135. (BILLING/COST CENTER # 56302920) Metro Services provides culturally appropriate therapeutic outpatient and rehabilitative group services to seriously and persistently mentally ill and homeless mentally ill consumers. Staff provides medication administration and education, monitor medication levels for consumers and perform physical and mental health assessments. 2. Older Adult Mental Health Clinic, 2025 E. Dakota Ave., Fresno, CA 93726, phone (559) 600-5755, fax (559) 229-2982. (BILLING/COST CENTER # 56304610) 3. Pathways to Recovery, Building 320, 515 S. Cedar Avenue, Fresno, CA 93702, phone (559) 600-6068, fax (559) 600-6090. (BILLING/COST CENTER # 56302093 and 56302096) Pathways to Recovery offers a three track program that provides outpatient substance abuse treatment services for pregnant and parenting women, mental health services for CalWORKs clients and co-occurring services for clients with co-existing mental health and substance abuse challenges. Revised Exhibit C Page 1 of 2 SCHEDULE OF FEES DEPARTMENT OF PUBLIC HEALTH TEST TEST UNIT CODE NAME PRICE 1. 14742 Amphetamine conf (GC/MS) $ 26.00 2. 4846 Cannabinoid conf (GC/MS) $127.55 3. 11328 Cocaine conf (GC/MS) $ 17.75 4. 15860 Opiates conf (GC/MS) $ 24.50 5. 6251 Phencyclidine (PCP) conf (GC/MS) $ 38.10 6. N/A Ethanol conf (GC/MS) N/A 7. 799 RPR (screening) $ 4.56 8. 285 Direct Bilirubin (CPT Code = 82248) $ 3.25 9. 287 Total Bilirubin (CPT Code = 82247) $ 3.25 10. 5463 Complete Urinalysis (CPT Code = 81000) $ 4.00 11. 4550 General Bacterial Culture $ 10.00 12. 484 Glucose $ 5.00 13. 480 Gonorrhea Culture $ 21.15 14. 497 Gram Stain $ 16.00 15. 7600 Lipid Panel $ 9.00 16. 10256 Liver Function Panel (CPT Code = 80061) $ 4.27 17. 622 Magnesium $ 10.00 18. 10165 Metabolic Panel (CPT Code = 80048) $ 4.46 19. 4503 Mycobacterial Acid Fast Smear $ 21.55 20. 4554 Mycobacterial Culture $ 97.40 21. 718 Phosphorus $ 3.25 22. 17304 SDA for Gonorrhea $ 25.00 23. 17303 SDA for Chlamydia $ 25.00 24. 809 Sed Rate (ESR) Westergren $ 11.15 25. 10108 Stool Culture $ 169.46 26. 859 T-3, Total (CPT Code = 84480) $ 28.40 27. 867 T-4, (Thyroxine), Total $ 16.30 28. 653 TPPA (confirmation) $ 86.00 29. 899 TSH $ 8.00 30. 905 Uric Acid $ 14.35 31. 8563 Urinalysis (Micro only)(CPT Code = 81002) $ 2.16 32. 6448 Urinalysis (w/o Micro)(CPT Code = 81015) $ 1.84 33. 395 Urine Culture $ 11.20 34. 4128 VDRL (CSF only) $ 26.35 35. 6399 CBC with Differential $ 5.00 36. 90858 Coccidioidal Serology Panel $ 153.92 37. 10231 Comprehensive Metabolic Panel* (CPT $ 5.57 Code = 80053; *different from Metabolic Panel Revised Exhibit C Page 2 of 2 SCHEDULE OF FEES DEPARTMENT OF PUBLIC HEALTH TEST TEST UNIT CODE NAME PRICE 38. 496 Hemoglobin A1C Immunoassay $ 47.00 39. 1759 Hemogram (BC w/ platelet count) $ 4.95 40. 512 Hepatitis A Antibody, IgM $ 11.00 41. 501 Hepatitis B Core Antibody $ 11.00 42. 8475 Hepatitis B Surface Antibody $ 11.00 43. 498 Hepatitis B Surface Antigen $ 11.00 44. 8472 Hepatitis C (Anti-HCV) $ 11.00 45. 6447 Herpes Simplex Virus, Type I and II, IgG $ 172.00* 46. 90849 Herpes Simplex Virus, Type I and II, IgM $ 101.00* 47. 10110 HIV 1 and HIV 2 Antibody (HIV Serology) $ 25.00 48. 5233 HIV 1 Western Blot $ 25.00 49. 40085 HIV-1 RNA, QUAL, Real Time PCR (Viral Load Tests) $ 291.00 50. 91431 HIV Screen Only $ 22.50 51. 7195 Lymphocyte Subset Panel $ 50.00 52. FPNR1 PAP, SurePath Focal Point $ 23.75 53. CYTP1 PAP, Thin Layer Prep $ 22.50 54. 5363 Prostate-specific Antigen $ 109.00 55. 8847 Prothrombin Time $ 13.70 56. 10314 Renal Function Panel (CPT Code = 80069) $ 4.83 57. 799 STS (Rapid Plasma Reagin) Qual $ 4.56 58. 899 Thyroid Stimulating Hormone $ 8.00 (3rd Generation) 59. 7195 T-Lymphocyte Helper/CD $ 50.00 60. 3679 Toxoplasma Gondii Antibody IgG $ 59.50 61. 91431 HIV-1/2 Antigens and Antibodies, $ 22.50 (4th Generation, with Reflexes, CPT 91431) 62. 91432 HIV-1/2 Antibody Differentiation, CPT 91432 $ 25.00 *Price increases (notifed by S. Butler on 11/4/15 that Herpes Simples Virus testing involved two separate tests and revised prices). Revised Exhibit D Page 1 of 2 SCHEDULE OF FEES DEPARTMENT OF BEHAVIORAL HEALTH TEST TEST UNIT CODE NAME PRICE 1. 10306 Acute Hepatitis Panel $ 44.00 2. 2128 Alcohol (Ethanol) Urine $ 75.00 3. 443 Alcohol, Ethyl (B) $ 50.00 4. 423 Amytriptyline $ 45.00 5. 14742 Amphetamine Conf by GC/MS, Urine $ 26.00 6. 10165 Basic Metabolic Panel $ 4.46 7. 8416 Barbiturates by CG/MS Urine $ 75.00 8. 8417 Benzodiazepines Conf (GC/MS) Urine $ 25.00 9. 3259 Blood drawing $ 8.00 10. 329 Carbamazinepine (Tegretol) $ 8.00 11. 6399 CBC (Includes Diff/Plt) $ 5.00 12. 1759 CBC (RBC, H/H, Indices, WBC, Plt) $ 4.95 13. 334 Cholesterol Direct LDL $ 2.00 14. 1769 Clozapine $ 18.75 15. 10231 Comprehensive Metabolic Panel $ 5.57 16. 395 Culture, Urine, Routine $ 11.20 17. 19733 Drug Abuse Panel 9, Serum $ 366.55 18. 2180 Drug Screen with Alcohol $ 25.00 19. 136140 Drug Test, General Toxicology, (B) $ 64.75 20. 136140 Drug Test, General Toxicology, (SP) $ 64.75 21. 29424 EIA 10 $ 50.00 22. 701089 EIA 10 + Alcohol $ 50.00 23. 701033 EIA7 + Alcohol w/ GC/MS $ 50.00 24. 701011 EIA 7 + Alcohol w/o Rflx $ 50.00 25. 457 Ferritin $ 25.00 26. 482 GGT $ 15.00 27. 483 Glucose $ 3.50 28. 484 Glucose, plasma $ 5.00 29. 396 HCG, Total QL $ 4.50 30. 8396 HCG, Total QL $ 14.00 31. 496 Hemoglobin A1C Immunoassay $ 10.00 32. 498 Hep B Surface Ag w/ Reflex Confirm $ 11.00 33. 10306 Hepatic Panel Acute w/ Ref $ 63.00 34. 10256 Hepatic Function Panel $ 4.27 35. 499 Hepatitis B Surface AB, Qual $ 25.00 36. 8472 Hepatitis C $ 11.00 37. 91431 HIV AB, HIV ½, EIA with Reflex $ 22.50 Revised Exhibit D Page 2 of 2 SCHEDULE OF FEES DEPARTMENT OF BEHAVIORAL HEALTH TEST TEST UNIT CODE NAME PRICE 38. 7573 Iron and IBC w/o Reflex $ 30.00 39. 14852 Lipid Panel with Reflex to Direct LDL $ 9.00* 40. 7600 Lipid Profile $ 9.00 41. 613 Lithium $ 6.00 42. 622 Magnesium, Serum $ 10.00 43. 4846 Marijuana Metabolite, Quant, Urine $ 127.55 44. 272 Nortriptyline $ 20.00 45. 70073 Olanzapine $ 160.00 46. 15860 Opiates, Confirmation by GC/MS, UR $ 24.50 47. 713 Phenytoin (Dilantin) $ 10.00 48. 733 Potassium, Serum $ 3.50* 49. 396 Pregnancy Test, Urine $ 4.50 50. 746 Prolactin $ 30.00 51. 5363 Prostate Specific Antigen (PSA) $ 109.00 52. 10314 Renal Function Panel $ 4.83 53. 2339 Risperidone $ 92.00 54. 701030 RPR/Reflex TPPA $ 70.00 55. 3820 STAT Charge $ 30.00 56. 701030 STS Titer + T. Pallidum-PA Reflex $ 70.00 57. 859 T3 Total (Triiodothyronine) $ 28.40 58. 861 T3 Uptake $ 10.00 59. 34429 T3, Free $ 50.00 60. 867 T4 (Thyroxine) $ 16.30 61. 866 T4, Free $ 10.00 62. 896 Triglycerides $ 25.00 63. 899 TSH $ 8.00 64. 36127 TSH Reflex to Free T4 $ 8.00* 65. 3020 Urinalysis C + S, If IND $ 4.00 66. 6448 Urinalysis Macroscopic $ 1.84 67. 8563 Urinalysis Microscopic $ 2.16 68. 5463 Urinalysis, Complete $ 4.00 69. 7909 Urinalysis, Macro w/Reflex to Micro $ 1.84* 70. 916 Valproic Acid $ 15.00 71. 7065 Vitamin B-12 and Folate $ 50.00 72. 17306 Vitamin D, 25-hydroxy, LC/MS/MS $ 75.00 *Prices reduced (notified of the price changes on 11/3/15).