ISOTOPES The purpose of this modification is to update Attachment 1 to add the quantities for the requested items for I-131 therapy capsule.   5

The purpose of this modification is to update Attachment 1 to add the quantities for the requested items to provide a quantity for I-131 therapy capsule. PRICE LIST FOR BASE YEAR POP: 10/19/2021-10/18/2022 ITEM UNIT QTY PRICE TOTAL PRICE Sestamibi LEU Dose 25 Myoview (Tetrofosmin) LEU Dose 1200 Thallium 201 per mCi 12 Tc99M Unit Dose< 40 mCi LEU <40 mCi 7 Tc99M bulk LEU per mCi 51,500 Tc99M MAA LEU Dose 27 Tc99M DTPA LEU <40 mCi 13 Tc99M MDP LEU Dose 265 Tc99M Mebrofenin (Choletec) LEU Dose 70 Tc99M Sulfur Colloid< 10 mCi LEU <10 mCi 10 Tc99M Sulfur Colloid Filtered LEU Dose 110 Tc99M Sulfur Colloid Gastric Emptying 75 Tc99M PYP Unit Dose LEU Dose 13 Tc99M MAG 3 Unit Dose LEU Dose 30 Tc99M Ceretec labled WBC study LEU Dose 4 Tc99M Ceretec brain Unit Dose LEU Dose 4 Tc99M Neurolite LEU Dose 4 Gallium 67 Per mCi 15mci I-123 diagnostic capsule 200 uCi 30 I-123 diagnostic capsule 100 uCi 5 I-131 therapy capsule, (1 mCi) mCi 1 I-131 therapy capsule, (each additional mCi) mCi 1 ln-111 Octreoscan per vial 5 ln-111 WBC study per vial 8 MAA per vial 10 DTPA per vial 10 MDP per vial 2 Cholectec - mebrofenin per vial 4 PYP - Sn Pyrophosphate per vial 2 Ultratag per vial 10 Kinevac per vial 45 WBC Kit each 10 Base Year Total $ $ $ *These items and quantities are to be considered as estimates only. Contractor is to invoice only for actual items delivered/received. PRICE LIST FOR OPTION YEAR 1 POP: 10/19/2022-10/18/2023 ITEM UNIT QTY PRICE TOTAL PRICE Sestamibi LEU Dose 25 Myoview (Tetrofosmin) LEU Dose 1200 Thallium 201 per mCi 12 Tc99M Unit Dose< 40 mCi LEU <40 mCi 7 Tc99M bulk LEU per mCi 51,500 Tc99M MAA LEU Dose 27 Tc99M DTPA LEU <40 mCi 13 Tc99M MDP LEU Dose 265 Tc99M Mebrofenin (Choletec) LEU Dose 70 Tc99M Sulfur Colloid< 10 mCi LEU <10 mCi 10 Tc99M Sulfur Colloid Filtered LEU Dose 110 Tc99M Sulfur Colloid Gastric Emptying 75 Tc99M PYP Unit Dose LEU Dose 13 Tc99M MAG 3 Unit Dose LEU Dose 30 Tc99M Ceretec labled WBC study LEU Dose 4 Tc99M Ceretec brain Unit Dose LEU Dose 4 Tc99M Neurolite LEU Dose 4 Gallium 67 Per mCi 15mci I-123 diagnostic capsule 200 uCi 30 I-123 diagnostic capsule 100 uCi 5 I-131 therapy capsule, (1 mCi) mCi 1 I-131 therapy capsule, (each additional mCi) mCi 1 ln-111 Octreoscan per vial 5 ln-111 WBC study per vial 8 MAA per vial 10 DTPA per vial 10 MDP per vial 2 Cholectec - mebrofenin per vial 4 PYP - Sn Pyrophosphate per vial 2 Ultratag per vial 10 Kinevac per vial 45 WBC Kit each 10 Option Year 1 Total $ $ *These items and quantities are to be considered as estimates only. Contractor is to invoice only for actual items delivered/received. PRICE LIST FOR OPTION YEAR 2 POP: 10/19/2023-10/18/2024 ITEM UNIT QTY PRICE TOTAL PRICE Sestamibi LEU Dose 25 Myoview (Tetrofosmin) LEU Dose 1200 Thallium 201 per mCi 12 Tc99M Unit Dose< 40 mCi LEU <40 mCi 7 Tc99M bulk LEU per mCi 51,500 Tc99M MAA LEU Dose 27 Tc99M DTPA LEU <40 mCi 13 Tc99M MDP LEU Dose 265 Tc99M Mebrofenin (Choletec) LEU Dose 70 Tc99M Sulfur Colloid< 10 mCi LEU <10 mCi 10 Tc99M Sulfur Colloid Filtered LEU Dose 110 Tc99M Sulfur Colloid Gastric Emptying 75 Tc99M PYP Unit Dose LEU Dose 13 Tc99M MAG 3 Unit Dose LEU Dose 30 Tc99M Ceretec labled WBC study LEU Dose 4 Tc99M Ceretec brain Unit Dose LEU Dose 4 Tc99M Neurolite LEU Dose 4 Gallium 67 Per mCi 15mci I-123 diagnostic capsule 200 uCi 30 I-123 diagnostic capsule 100 uCi 5 I-131 therapy capsule, (1 mCi) mCi 1 I-131 therapy capsule, (each additional mCi) mCi 1 ln-111 Octreoscan per vial 5 ln-111 WBC study per vial 8 MAA per vial 10 DTPA per vial 10 MDP per vial 2 Cholectec - mebrofenin per vial 4 PYP - Sn Pyrophosphate per vial 2 Ultratag per vial 10 Kinevac per vial 45 WBC Kit each 10 Option Year 2 Total $ $ *These items and quantities are to be considered as estimates only. Contractor is to invoice only for actual items delivered/received. PRICE LIST FOR OPTION YEAR 3 POP: 10/19/2024-10/18/2025 ITEM UNIT QTY PRICE TOTAL PRICE Sestamibi LEU Dose 25 Myoview (Tetrofosmin) LEU Dose 1200 Thallium 201 per mCi 12 Tc99M Unit Dose< 40 mCi LEU <40 mCi 7 Tc99M bulk LEU per mCi 51,500 Tc99M MAA LEU Dose 27 Tc99M DTPA LEU <40 mCi 13 Tc99M MDP LEU Dose 265 Tc99M Mebrofenin (Choletec) LEU Dose 70 Tc99M Sulfur Colloid< 10 mCi LEU <10 mCi 10 Tc99M Sulfur Colloid Filtered LEU Dose 110 Tc99M Sulfur Colloid Gastric Emptying 75 Tc99M PYP Unit Dose LEU Dose 13 Tc99M MAG 3 Unit Dose LEU Dose 30 Tc99M Ceretec labled WBC study LEU Dose 4 Tc99M Ceretec brain Unit Dose LEU Dose 4 Tc99M Neurolite LEU Dose 4 Gallium 67 Per mCi 15mci I-123 diagnostic capsule 200 uCi 30 I-123 diagnostic capsule 100 uCi 5 I-131 therapy capsule, (1 mCi) mCi 1 I-131 therapy capsule, (each additional mCi) mCi 1 ln-111 Octreoscan per vial 5 ln-111 WBC study per vial 8 MAA per vial 10 DTPA per vial 10 MDP per vial 2 Cholectec - mebrofenin per vial 4 PYP - Sn Pyrophosphate per vial 2 Ultratag per vial 10 Kinevac per vial 45 WBC Kit each 10 Option Year 3 Total $ $ *These items and quantities are to be considered as estimates only. Contractor is to invoice only for actual items delivered/received. PRICE LIST FOR OPTION YEAR 4 POP: 10/19/2025-10/18/2026 ITEM UNIT QTY PRICE TOTAL PRICE Sestamibi LEU Dose 25 Myoview (Tetrofosmin) LEU Dose 1200 Thallium 201 per mCi 12 Tc99M Unit Dose< 40 mCi LEU <40 mCi 7 Tc99M bulk LEU per mCi 51,500 Tc99M MAA LEU Dose 27 Tc99M DTPA LEU <40 mCi 13 Tc99M MDP LEU Dose 265 Tc99M Mebrofenin (Choletec) LEU Dose 70 Tc99M Sulfur Colloid< 10 mCi LEU <10 mCi 10 Tc99M Sulfur Colloid Filtered LEU Dose 110 Tc99M Sulfur Colloid Gastric Emptying 75 Tc99M PYP Unit Dose LEU Dose 13 Tc99M MAG 3 Unit Dose LEU Dose 30 Tc99M Ceretec labled WBC study LEU Dose 4 Tc99M Ceretec brain Unit Dose LEU Dose 4 Tc99M Neurolite LEU Dose 4 Gallium 67 Per mCi 15mci I-123 diagnostic capsule 200 uCi 30 I-123 diagnostic capsule 100 uCi 5 I-131 therapy capsule, (1 mCi) mCi 1 I-131 therapy capsule, (each additional mCi) mCi 1 ln-111 Octreoscan per vial 5 ln-111 WBC study per vial 8 MAA per vial 10 DTPA per vial 10 MDP per vial 2 Cholectec - mebrofenin per vial 4 PYP - Sn Pyrophosphate per vial 2 Ultratag per vial 10 Kinevac per vial 45 WBC Kit each 10 Option Year 4 Total $ $ *These items and quantities are to be considered as estimates only. Contractor is to invoice only for actual items delivered/received.