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.

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