Copy of ATTACHMENT B Unit Pricing Schedule for Exams.xlsx

XLSX spreadsheet 34 KB Posted Jul 21, 2023

Attached to: Disability Medical Exams for the Railroad Retirement Board
Solicitation number: 60RRBH23R0011
Issued by: Railroad Retirement Board

About this file

Written by GovTribe AI · Dec 21, 2023

This document contains a pricing attachment for a federal contract solicitation for disability medical exams. The solicitation from the Railroad Retirement Board seeks pricing for various medical exams and tests to be provided over a one year base period and four one-year option periods. Pricing is provided for over 300 different exam and test types in a unit pricing table format listing the estimated annual volume and unit price for each exam and test. The total estimated contract value will be determined by applying the unit prices to the actual volume of exams and tests ordered over the five year period. This competitive solicitation appears aimed at establishing an ID/IQ-type contract vehicle to allow for ordering various medical services on an as-needed basis to support the disability programs administered by the Railroad Retirement Board.

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Other files

File	Type	Posted
60RRBH23R0011 001.pdf	PDF	Jul 21, 2023
Released version 60RRBH23R0011 Disability Medical Exams 2023.pdf	PDF	Jun 22, 2023
Attachment D Offices of the the U.S. RRB and District Office Map.pdf	PDF	Jun 22, 2023
Attachment C 2023 Average Railroad Employment by State.docx	DOCX document	Jun 22, 2023
Attachment F 2023 Subcontracting Plan.doc	DOC document	Jun 22, 2023
Exhibit 4 Physical Resdual Funtional Capacity Assessment.pdf	PDF	Jun 22, 2023
Attachment H 2023-1 CE Protocols with Possible Additions.pdf	PDF	Jun 22, 2023
Attachment B Unit Pricing Schedule Exam-Tests Estimated Orders.pdf	PDF	Jun 22, 2023
Exhibit 3 2023 Revised Ancillary Test.docx	DOCX document	Jun 22, 2023
Exhibit 2 Revised Consultative Examination Protocols.docx	DOCX document	Jun 22, 2023
Attachment G Past Performance Questionnaire.docx	DOCX document	Jun 22, 2023
Exhibit 1 2023 Exam Reason Beneficiary Type.docx	DOCX document	Jun 22, 2023
Attachment E 2023 Implementation Plan.doc	DOC document	Jun 22, 2023
Exhibit 5 Mental Residual Functional Capacity Assessment.pdf	PDF	Jun 22, 2023
Attachment A FY22 Ordered Urgent Routine Exams-Tests.docx	DOCX document	Jun 22, 2023

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Price Summary Attachment B - Unit Pricing Summary

VENDOR NAME:

CLIN 0001

CLIN 0002

CLIN 0003

CLIN 0004

CLIN 0005

TOTAL =

CLIN 0001

CLIN 0001 - BASE PERIOD

Examination/Test Number	Examination/Test Name	Estimated No. Ordered Annually	UNIT PRICE (EACH)	Extended (Total) Price
1	Dermatologist Exam	5
3	Otolaryngology (ear exam) , including audiometric test with air and bone conduction pure tone studies with speech discrimination	35
5	Otolaryngology (ear exam), including audiometric test and an ENG or caloric test	5
6	Otolaryngology (ear exam), including a speech discrimination test with a hearing in noise test (HINT)	5
7	Ophthalmology (eye exam)	60
11	I. Q. Evaluation with psychometric testing	40
12	Neurologist Exam	10
13	Psychiatric Exam	700
14	Minnesota Multi-phasic Personality Inventory	5
16	Orthopedic Exam	650
17	Internal Medicine Exam with orthopedic involvement	950
18	Internal Medicine Exam	150
20	Serum Protein Electrophoresis	5
23	Arterial Blood Gas Studies (resting)	5
24	PT (Prothrombin Time) and INR (International Normalized Ratio)	5
26	A1C ( also known as glycated hemoglobin HbA1c) test	5
28	Hematocrit	5
30	Complete blood cell count (CBC)	10
31	Blood Panel, including HgA1c and Hemoccult	0
32	Serum Creatinine; if not available, do BUN (blood urea nitrogen) or NPN (non-protein nitrogen)	5
33	Serum Albumin	5
34	Erythrocyte Sedimentation Rate	5
36	SMA Series (SMA-12, etc)	10
37	Anti-convulsant Serum Level	5
38	Liver function studies	10
39	Thyroid Evaluation	5
40	Electro-encephalogram	5
41	Pulmonary Function Test, spirometry	100
42	Diffusing Capacity/Lungs (DLCO)	5
43	Stress (treadmill or bicycle) test with monitoring. Submit interpretation and sample tracings.	5
44	Rheumatoid Factor	5
45	Electrocardiogram (EKG) with interpretation, submit tracing	200
46	Doppler Ultrasound Flow Detection Tech.	5
47	Urinalysis	10
48	Antinuclear Antibody	5
052/152	Left/Right ankle joint, anteroposterior, lateral views, and oblique (x-ray)	50
053/153	Left/Right arm humerus, anteroposterior, lateral views, and oblique (x-ray)	5
55	Chest, anteroposterior and lateral (x-ray)	220
058/158	Left/Right elbow, anteroposterior, lateral views and oblique (x-ray)	10
062/162	Left/Right foot, anteroposterior, lateral views and oblique. (x-ray)	50
063/163	Left/Right forearm, anteroposterior, lateral views and oblique. (x-ray)	5
067/167	Left/Right hand, anteroposterior, lateral views and oblique. (x-ray)	30
68	Hip joints (right and left on one film) anteroposterior view (x-ray)	60
073/173	Left/Right knee joint, anteroposterior, lateral views and oblique. (x-ray)	220
075/175	Left/Right leg, tibia and fibular, anteroposterior, lateral views (x-ray)	15
079/179	Left/Right shoulder joint, anteroposterior view, internal and external rotation (x-ray)	200
85	Skull, anteroposterior, right and left lateral frontal and basal occipital (x-ray)	5
87	Spine, cervical, anteroposterior and lateral views odontoid (x-ray)	200
88	Spine, dorsal, anteroposterior and lateral views, 14X17 film (x-ray)	10
89	Spine, lumbo-sacral, anteroposterior and lateral views, 14X17 film (x-ray)	400
092/192	Left/Right thigh, femur, survey film (x-ray)	5
094/194	Left/Right wrist, anteroposterior and lateral views (x-ray)	20
101	Cardiology Specialist Exam	5
106	Otolaryngology HINT Specialist Exam	0
112	Neurologist Specialist Exam	0
113	Psychiatric Specialist Exam	0
116	Orthopedic Specialist Exam	5
123	Arterial Blood Gas (exercise)	5
200	Functional Capacity Evaluation	5
300	Cervical Spine CT Scan	2
301	Lumbar Spine CT Scan	2
302	Shoulder CT Scan	2
303	Knee CT Scan	2
304	Hip CT Scan	2
305	Cervical Spine MRI without contrast	5
306	Lumbar Spine MRI without contrast	5
307	Shoulder MRI without contrast	5
308	Knee MRI without contrast	2
309	Hip MRI without contrast	2
					TOTAL PRICE of ALL EXAMS =

CLIN 0002

CLIN 0002 - OPTION PERIOD ONE

Examination/Test Number	Examination/Test Name	Estimated No. Ordered Annually	UNIT PRICE (EACH)	Extended (Total) Price
1	Dermatologist Exam	5
3	Otolaryngology (ear exam) , including audiometric test with air and bone conduction pure tone studies with speech discrimination	35
5	Otolaryngology (ear exam), including audiometric test and an ENG or caloric test	5
6	Otolaryngology (ear exam), including a speech discrimination test with a hearing in noise test (HINT)	5
7	Ophthalmology (eye exam)	60
11	I. Q. Evaluation with psychometric testing	40
12	Neurologist Exam	10
13	Psychiatric Exam	700
14	Minnesota Multi-phasic Personality Inventory	5
16	Orthopedic Exam	650
17	Internal Medicine Exam with orthopedic involvement	950
18	Internal Medicine Exam	150
20	Serum Protein Electrophoresis	5
23	Arterial Blood Gas Studies (resting)	5
24	PT (Prothrombin Time) and INR (International Normalized Ratio)	5
26	A1C ( also known as glycated hemoglobin HbA1c) test	5
28	Hematocrit	5
30	Complete blood cell count (CBC)	10
31	Blood Panel, including HgA1c and Hemoccult	0
32	Serum Creatinine; if not available, do BUN (blood urea nitrogen) or NPN (non-protein nitrogen)	5
33	Serum Albumin	5
34	Erythrocyte Sedimentation Rate	5
36	SMA Series (SMA-12, etc)	10
37	Anti-convulsant Serum Level	5
38	Liver function studies	10
39	Thyroid Evaluation	5
40	Electro-encephalogram	5
41	Pulmonary Function Test, spirometry	100
42	Diffusing Capacity/Lungs (DLCO)	5
43	Stress (treadmill or bicycle) test with monitoring. Submit interpretation and sample tracings.	5
44	Rheumatoid Factor	5
45	Electrocardiogram (EKG) with interpretation, submit tracing	200
46	Doppler Ultrasound Flow Detection Tech.	5
47	Urinalysis	10
48	Antinuclear Antibody	5
052/152	Left/Right ankle joint, anteroposterior, lateral views, and oblique (x-ray)	50
053/153	Left/Right arm humerus, anteroposterior, lateral views, and oblique (x-ray)	5
55	Chest, anteroposterior and lateral (x-ray)	220
058/158	Left/Right elbow, anteroposterior, lateral views and oblique (x-ray)	10
062/162	Left/Right foot, anteroposterior, lateral views and oblique. (x-ray)	50
063/163	Left/Right forearm, anteroposterior, lateral views and oblique. (x-ray)	5
067/167	Left/Right hand, anteroposterior, lateral views and oblique. (x-ray)	30
68	Hip joints (right and left on one film) anteroposterior view (x-ray)	60
073/173	Left/Right knee joint, anteroposterior, lateral views and oblique. (x-ray)	220
075/175	Left/Right leg, tibia and fibular, anteroposterior, lateral views (x-ray)	15
079/179	Left/Right shoulder joint, anteroposterior view, internal and external rotation (x-ray)	200
85	Skull, anteroposterior, right and left lateral frontal and basal occipital (x-ray)	5
87	Spine, cervical, anteroposterior and lateral views odontoid (x-ray)	200
88	Spine, dorsal, anteroposterior and lateral views, 14X17 film (x-ray)	10
89	Spine, lumbo-sacral, anteroposterior and lateral views, 14X17 film (x-ray)	400
092/192	Left/Right thigh, femur, survey film (x-ray)	5
094/194	Left/Right wrist, anteroposterior and lateral views (x-ray)	20
101	Cardiology Specialist Exam	5
106	Otolaryngology HINT Specialist Exam	0
112	Neurologist Specialist Exam	0
113	Psychiatric Specialist Exam	0
116	Orthopedic Specialist Exam	5
123	Arterial Blood Gas (exercise)	5
200	Functional Capacity Evaluation	5
300	Cervical Spine CT Scan	2
301	Lumbar Spine CT Scan	2
302	Shoulder CT Scan	2
303	Knee CT Scan	2
304	Hip CT Scan	2
305	Cervical Spine MRI without contrast	5
306	Lumbar Spine MRI without contrast	5
307	Shoulder MRI without contrast	5
308	Knee MRI without contrast	2
309	Hip MRI without contrast	2
					TOTAL PRICE of ALL EXAMS =

CLIN 0003

CLIN 0003 - OPTION PERIOD TWO

Examination/Test Number	Examination/Test Name	Estimated No. Ordered Annually	UNIT PRICE (EACH)	Extended (Total) Price
1	Dermatologist Exam	5
3	Otolaryngology (ear exam) , including audiometric test with air and bone conduction pure tone studies with speech discrimination	35
5	Otolaryngology (ear exam), including audiometric test and an ENG or caloric test	5
6	Otolaryngology (ear exam), including a speech discrimination test with a hearing in noise test (HINT)	5
7	Ophthalmology (eye exam)	60
11	I. Q. Evaluation with psychometric testing	40
12	Neurologist Exam	10
13	Psychiatric Exam	700
14	Minnesota Multi-phasic Personality Inventory	5
16	Orthopedic Exam	650
17	Internal Medicine Exam with orthopedic involvement	950
18	Internal Medicine Exam	150
20	Serum Protein Electrophoresis	5
23	Arterial Blood Gas Studies (resting)	5
24	PT (Prothrombin Time) and INR (International Normalized Ratio)	5
26	A1C ( also known as glycated hemoglobin HbA1c) test	5
28	Hematocrit	5
30	Complete blood cell count (CBC)	10
31	Blood Panel, including HgA1c and Hemoccult	0
32	Serum Creatinine; if not available, do BUN (blood urea nitrogen) or NPN (non-protein nitrogen)	5
33	Serum Albumin	5
34	Erythrocyte Sedimentation Rate	5
36	SMA Series (SMA-12, etc)	10
37	Anti-convulsant Serum Level	5
38	Liver function studies	10
39	Thyroid Evaluation	5
40	Electro-encephalogram	5
41	Pulmonary Function Test, spirometry	100
42	Diffusing Capacity/Lungs (DLCO)	5
43	Stress (treadmill or bicycle) test with monitoring. Submit interpretation and sample tracings.	5
44	Rheumatoid Factor	5
45	Electrocardiogram (EKG) with interpretation, submit tracing	200
46	Doppler Ultrasound Flow Detection Tech.	5
47	Urinalysis	10
48	Antinuclear Antibody	5
052/152	Left/Right ankle joint, anteroposterior, lateral views, and oblique (x-ray)	50
053/153	Left/Right arm humerus, anteroposterior, lateral views, and oblique (x-ray)	5
55	Chest, anteroposterior and lateral (x-ray)	220
058/158	Left/Right elbow, anteroposterior, lateral views and oblique (x-ray)	10
062/162	Left/Right foot, anteroposterior, lateral views and oblique. (x-ray)	50
063/163	Left/Right forearm, anteroposterior, lateral views and oblique. (x-ray)	5
067/167	Left/Right hand, anteroposterior, lateral views and oblique. (x-ray)	30
68	Hip joints (right and left on one film) anteroposterior view (x-ray)	60
073/173	Left/Right knee joint, anteroposterior, lateral views and oblique. (x-ray)	220
075/175	Left/Right leg, tibia and fibular, anteroposterior, lateral views (x-ray)	15
079/179	Left/Right shoulder joint, anteroposterior view, internal and external rotation (x-ray)	200
85	Skull, anteroposterior, right and left lateral frontal and basal occipital (x-ray)	5
87	Spine, cervical, anteroposterior and lateral views odontoid (x-ray)	200
88	Spine, dorsal, anteroposterior and lateral views, 14X17 film (x-ray)	10
89	Spine, lumbo-sacral, anteroposterior and lateral views, 14X17 film (x-ray)	400
092/192	Left/Right thigh, femur, survey film (x-ray)	5
094/194	Left/Right wrist, anteroposterior and lateral views (x-ray)	20
101	Cardiology Specialist Exam	5
106	Otolaryngology HINT Specialist Exam	0
112	Neurologist Specialist Exam	0
113	Psychiatric Specialist Exam	0
116	Orthopedic Specialist Exam	5
123	Arterial Blood Gas (exercise)	5
200	Functional Capacity Evaluation	5
300	Cervical Spine CT Scan	2
301	Lumbar Spine CT Scan	2
302	Shoulder CT Scan	2
303	Knee CT Scan	2
304	Hip CT Scan	2
305	Cervical Spine MRI without contrast	5
306	Lumbar Spine MRI without contrast	5
307	Shoulder MRI without contrast	5
308	Knee MRI without contrast	2
309	Hip MRI without contrast	2
					TOTAL PRICE of ALL EXAMS =

CLIN 0004

CLIN 0004 - OPTION PERIOD THREE

Examination/Test Number	Examination/Test Name	Estimated No. Ordered Annually	UNIT PRICE (EACH)	Extended (Total) Price
1	Dermatologist Exam	5
3	Otolaryngology (ear exam) , including audiometric test with air and bone conduction pure tone studies with speech discrimination	35
5	Otolaryngology (ear exam), including audiometric test and an ENG or caloric test	5
6	Otolaryngology (ear exam), including a speech discrimination test with a hearing in noise test (HINT)	5
7	Ophthalmology (eye exam)	60
11	I. Q. Evaluation with psychometric testing	40
12	Neurologist Exam	10
13	Psychiatric Exam	700
14	Minnesota Multi-phasic Personality Inventory	5
16	Orthopedic Exam	650
17	Internal Medicine Exam with orthopedic involvement	950
18	Internal Medicine Exam	150
20	Serum Protein Electrophoresis	5
23	Arterial Blood Gas Studies (resting)	5
24	PT (Prothrombin Time) and INR (International Normalized Ratio)	5
26	A1C ( also known as glycated hemoglobin HbA1c) test	5
28	Hematocrit	5
30	Complete blood cell count (CBC)	10
31	Blood Panel, including HgA1c and Hemoccult	0
32	Serum Creatinine; if not available, do BUN (blood urea nitrogen) or NPN (non-protein nitrogen)	5
33	Serum Albumin	5
34	Erythrocyte Sedimentation Rate	5
36	SMA Series (SMA-12, etc)	10
37	Anti-convulsant Serum Level	5
38	Liver function studies	10
39	Thyroid Evaluation	5
40	Electro-encephalogram	5
41	Pulmonary Function Test, spirometry	100
42	Diffusing Capacity/Lungs (DLCO)	5
43	Stress (treadmill or bicycle) test with monitoring. Submit interpretation and sample tracings.	5
44	Rheumatoid Factor	5
45	Electrocardiogram (EKG) with interpretation, submit tracing	200
46	Doppler Ultrasound Flow Detection Tech.	5
47	Urinalysis	10
48	Antinuclear Antibody	5
052/152	Left/Right ankle joint, anteroposterior, lateral views, and oblique (x-ray)	50
053/153	Left/Right arm humerus, anteroposterior, lateral views, and oblique (x-ray)	5
55	Chest, anteroposterior and lateral (x-ray)	220
058/158	Left/Right elbow, anteroposterior, lateral views and oblique (x-ray)	10
062/162	Left/Right foot, anteroposterior, lateral views and oblique. (x-ray)	50
063/163	Left/Right forearm, anteroposterior, lateral views and oblique. (x-ray)	5
067/167	Left/Right hand, anteroposterior, lateral views and oblique. (x-ray)	30
68	Hip joints (right and left on one film) anteroposterior view (x-ray)	60
073/173	Left/Right knee joint, anteroposterior, lateral views and oblique. (x-ray)	220
075/175	Left/Right leg, tibia and fibular, anteroposterior, lateral views (x-ray)	15
079/179	Left/Right shoulder joint, anteroposterior view, internal and external rotation (x-ray)	200
85	Skull, anteroposterior, right and left lateral frontal and basal occipital (x-ray)	5
87	Spine, cervical, anteroposterior and lateral views odontoid (x-ray)	200
88	Spine, dorsal, anteroposterior and lateral views, 14X17 film (x-ray)	10
89	Spine, lumbo-sacral, anteroposterior and lateral views, 14X17 film (x-ray)	400
092/192	Left/Right thigh, femur, survey film (x-ray)	5
094/194	Left/Right wrist, anteroposterior and lateral views (x-ray)	20
101	Cardiology Specialist Exam	5
106	Otolaryngology HINT Specialist Exam	0
112	Neurologist Specialist Exam	0
113	Psychiatric Specialist Exam	0
116	Orthopedic Specialist Exam	5
123	Arterial Blood Gas (exercise)	5
200	Functional Capacity Evaluation	5
300	Cervical Spine CT Scan	2
301	Lumbar Spine CT Scan	2
302	Shoulder CT Scan	2
303	Knee CT Scan	2
304	Hip CT Scan	2
305	Cervical Spine MRI without contrast	5
306	Lumbar Spine MRI without contrast	5
307	Shoulder MRI without contrast	5
308	Knee MRI without contrast	2
309	Hip MRI without contrast	2
					TOTAL PRICE of ALL EXAMS =

CLIN 0005

CLIN 0005 - OPTION PERIOD FOUR

Examination/Test Number	Examination/Test Name	Estimated No. Ordered Annually	UNIT PRICE (EACH)	Extended (Total) Price
1	Dermatologist Exam	5
3	Otolaryngology (ear exam) , including audiometric test with air and bone conduction pure tone studies with speech discrimination	35
5	Otolaryngology (ear exam), including audiometric test and an ENG or caloric test	5
6	Otolaryngology (ear exam), including a speech discrimination test with a hearing in noise test (HINT)	5
7	Ophthalmology (eye exam)	60
11	I. Q. Evaluation with psychometric testing	40
12	Neurologist Exam	10
13	Psychiatric Exam	700
14	Minnesota Multi-phasic Personality Inventory	5
16	Orthopedic Exam	650
17	Internal Medicine Exam with orthopedic involvement	950
18	Internal Medicine Exam	150
20	Serum Protein Electrophoresis	5
23	Arterial Blood Gas Studies (resting)	5
24	PT (Prothrombin Time) and INR (International Normalized Ratio)	5
26	A1C ( also known as glycated hemoglobin HbA1c) test	5
28	Hematocrit	5
30	Complete blood cell count (CBC)	10
31	Blood Panel, including HgA1c and Hemoccult	0
32	Serum Creatinine; if not available, do BUN (blood urea nitrogen) or NPN (non-protein nitrogen)	5
33	Serum Albumin	5
34	Erythrocyte Sedimentation Rate	5
36	SMA Series (SMA-12, etc)	10
37	Anti-convulsant Serum Level	5
38	Liver function studies	10
39	Thyroid Evaluation	5
40	Electro-encephalogram	5
41	Pulmonary Function Test, spirometry	100
42	Diffusing Capacity/Lungs (DLCO)	5
43	Stress (treadmill or bicycle) test with monitoring. Submit interpretation and sample tracings.	5
44	Rheumatoid Factor	5
45	Electrocardiogram (EKG) with interpretation, submit tracing	200
46	Doppler Ultrasound Flow Detection Tech.	5
47	Urinalysis	10
48	Antinuclear Antibody	5
052/152	Left/Right ankle joint, anteroposterior, lateral views, and oblique (x-ray)	50
053/153	Left/Right arm humerus, anteroposterior, lateral views, and oblique (x-ray)	5
55	Chest, anteroposterior and lateral (x-ray)	220
058/158	Left/Right elbow, anteroposterior, lateral views and oblique (x-ray)	10
062/162	Left/Right foot, anteroposterior, lateral views and oblique. (x-ray)	50
063/163	Left/Right forearm, anteroposterior, lateral views and oblique. (x-ray)	5
067/167	Left/Right hand, anteroposterior, lateral views and oblique. (x-ray)	30
68	Hip joints (right and left on one film) anteroposterior view (x-ray)	60
073/173	Left/Right knee joint, anteroposterior, lateral views and oblique. (x-ray)	220
075/175	Left/Right leg, tibia and fibular, anteroposterior, lateral views (x-ray)	15
079/179	Left/Right shoulder joint, anteroposterior view, internal and external rotation (x-ray)	200
85	Skull, anteroposterior, right and left lateral frontal and basal occipital (x-ray)	5
87	Spine, cervical, anteroposterior and lateral views odontoid (x-ray)	200
88	Spine, dorsal, anteroposterior and lateral views, 14X17 film (x-ray)	10
89	Spine, lumbo-sacral, anteroposterior and lateral views, 14X17 film (x-ray)	400
092/192	Left/Right thigh, femur, survey film (x-ray)	5
094/194	Left/Right wrist, anteroposterior and lateral views (x-ray)	20
101	Cardiology Specialist Exam	5
106	Otolaryngology HINT Specialist Exam	0
112	Neurologist Specialist Exam	0
113	Psychiatric Specialist Exam	0
116	Orthopedic Specialist Exam	5
123	Arterial Blood Gas (exercise)	5
200	Functional Capacity Evaluation	5
300	Cervical Spine CT Scan	2
301	Lumbar Spine CT Scan	2
302	Shoulder CT Scan	2
303	Knee CT Scan	2
304	Hip CT Scan	2
305	Cervical Spine MRI without contrast	5
306	Lumbar Spine MRI without contrast	5
307	Shoulder MRI without contrast	5
308	Knee MRI without contrast	2
309	Hip MRI without contrast	2
					TOTAL PRICE of ALL EXAMS =

File details come from the government source that posted it. Updated Jul 21, 2023.