2.2.1- ATTACHMENT 4_PRICING TEMPLATE_70B06C26R00000017 A0001.xlsx

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Medical Support Services for CBP (including medical exams, fitness for duty, drug testing, and related services)
Solicitation number
70B06C26R00000017
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Written by GovTribe AI ·

This is a Pricing Template for an Indefinite Delivery/Indefinite Quantity (IDIQ) firm fixed unit price contract for comprehensive Medical Support Services to the U.S. Customs and Border Protection (CBP). The template covers five 12-month ordering periods with a total estimated contract value of $20,000 across all periods, allocated equally at $20,000 per ordering period, with travel costs already pre-populated at $10,000 per ordering period for medical services travel and MRO/laboratory travel.

The pricing template requires offerors to provide unit pricing for 116 Contract Line Item Numbers (CLINs) organized across multiple service categories: Medical Examinations (including initial medical exams, independent medical exams, psychiatric evaluations, and no-show fees); Non-Psychiatric Consultations (tiered by document complexity from 1-1000+ pages); Psychiatric Specialist Consultations (tiered from Level I through X based on case complexity); Fitness Test Services (pre-employment tests for Border Patrol Agents, Customs and Border Protection Officers, and Agricultural/Marine/Air/Detection Enforcement Officers, including overseas locations); Drug Program Services (pre-employment and post-employment drug testing, MRO services, specimen handling, and litigation packages); Additional Medical Tests (diagnostic imaging, laboratory tests, and specialized evaluations); and Development of Medical Standards and Clinical Policy Consultation. The template emphasizes that all unit prices must be proposed for highlighted cells regardless of estimated quantity, that travel costs are not-to-exceed amounts that cannot be modified, that cancellation fees must be incorporated into unit pricing, and that as an IDIQ contract, offerors are not guaranteed any minimum quantities but must be prepared to fulfill orders at proposed fixed unit prices for any combination of CLINs based on government need.

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Summary - TECV

DO NOT fill in values on this worksheet
70B06C26R00000017 SummaryTEV
Ordering Period 1$ 20,000.00
Ordering Period 2$ - 0
Ordering Period 3$ - 0
Ordering Period 4$ - 0
Ordering Period 5$ - 0
Total Estimated Contract Value [TECV]$ 20,000.00
Instructions for Completing the Pricing Schedule

ON the other worksheets, offerors must provide unit pricing for numbered CLINs listed. All unit prices should be entered in the designated column for each CLIN.

Travel Reimbursement: Travel costs will be reimbursed in accordance with Federal Travel Regulations. The values for travel are “Not-To-Exceed” (NTE) amounts and have already been entered in the pricing schedule. Offerors shall not modify these NTE values.

IDIQ Contract Structure: This solicitation is for an Indefinite Delivery/Indefinite Quantity (IDIQ) contract. The quantities provided in the pricing schedule are estimates only and are for evaluation purposes.

Actual orders will be placed using fixed unit price line items of funding for any combination of CLINs, based on the Government’s needs.

Order Placement: Orders may be placed for any CLIN(s) listed in the schedule, in any quantity, at the fixed unit price proposed.

Offerors are not guaranteed any minimum quantity and should be prepared to fulfill orders as required.

General Notes: Any cancellation fees shall be considered a cost of doing business and are not separately priced. Offerors must incorporate such costs into their unit pricing.

Comprehensive Health Services, LLC U.S. Customs and Border Protection Solicitation: 70B06C20R00000044 Medical Services

Use or disclosure of data contained on this sheet is subject to the restrictions on the title page of this proposal.

OP1 (Base)

Ordering Period 170B06C26R00000017- Base [Ordering Period 1]
Instructions for Completing the Pricing Schedule

On the other worksheets, offerors must provide unit pricing for numbered CLINs listed. All unit prices should be entered in the designated column for each CLIN.

Travel Reimbursement: Travel costs will be reimbursed in accordance with Federal Travel Regulations. The values for travel are “Not-To-Exceed” (NTE) amounts and have already been entered in the pricing schedule. Offerors shall not modify these NTE values. Vendors shall offer unit pricing for all highlighted cells, even if there is a zero entered for quantity.

IDIQ Contract Structure: This solicitation is for an Indefinite Delivery/Indefinite Quantity (IDIQ) contract. The quantities provided in the pricing schedule are estimates only and are for evaluation purposes.

Actual orders will be placed using fixed unit price line items of funding for any combination of CLINs, based on the Government’s needs.

Order Placement: Orders may be placed for any CLIN(s) listed in the schedule, in any quantity, at the fixed unit price proposed.

Offerors are not guaranteed any minimum quantity and should be prepared to fulfill orders as required.

General Notes: Any cancellation fees shall be considered a cost of doing business and are not separately priced. Offerors must incorporate such costs into their unit pricing.

Program CategoryDescription_Unit PriceExtended Value
Est QTYUnit
CLIN
1000Transition
Medical Services
Medical Examinations (IME: Cost includes evaluation, physician review, cancellation, and all administrative fees.)
1001PREIME (including physician review)1$ - 0each$ - 0
1002PRENo show fee IME (day of appointment)1$ - 0each$ - 0
1003PREPsychiatric IME (including physician review)1$ - 0each$ - 0
1004PREPre-employment medical exam - all positions115,000$ - 0each$ - 0
1005PREPre-employment medical exam/drug test combination1$ - 0each$ - 0
1006PREPre-employment fitness test/drug test combination1$ - 0each$ - 0
1007PREPre-employment medical exam/fitness test combination1$ - 0each$ - 0
1008PREPre-employment medical exam/fitness test/drug test combination1$ - 0each$ - 0
1009PREPre-employment Overseas Medical Examination1$ - 0each$ - 0
1010POSTEmployee medical examination (including physician review)130$ - 0each$ - 0
1011POSTNo show fee for employee medical examination8$ - 0each$ - 0
1012POSTIME (including physician review)75$ - 0each$ - 0
1013POSTNo show fee (day of appointment)10$ - 0Lot$ - 0
1014POSTPsychiatric IME75$ - 0each$ - 0
1015POSTMedical Hardship/Medical Reassignment I100$ - 0each$ - 0
1016POSTMedical Hardship/Medical Reassignment II100$ - 0each$ - 0
Non-Psychiatric Consultation
1017PRENon-Psychiatric Consultation Level I5,000$ - 0each$ - 0
1018PRENon-Psychiatric Consultation Level 2-1 (100 pages or less)50$ - 0each$ - 0
1019PRENon-Psychiatric Consultation Level 2-2 (101-200 pages)100$ - 0each$ - 0
1020PRENon-Psychiatric Consultation Level 2-3 (201-300 pages)100$ - 0each$ - 0
1021PRENon-Psychiatric Consultation Level 2-4 (301-400 pages)100$ - 0each$ - 0
1022PRENon-Psychiatric Consultation Level 2-5 (401-500 pages)100$ - 0each$ - 0
1023PRENon-Psychiatric Consultation Level 2-6 (501-600 pages)40$ - 0each$ - 0
1024PRENon-Psychiatric Consultation Level 2-7 (601-700 pages)40$ - 0each$ - 0
1025PRENon-Psychiatric Consultation Level 2-8 (701-800 pages)40$ - 0each$ - 0
1026PRENon-Psychiatric Consultation Level 2-9 (801-900 pages)5$ - 0each$ - 0
1027PRENon-Psychiatric Consultation Level 2-10 (901-1000 pages)5$ - 0each$ - 0
1028PRENon-Psychiatric Level III Specialist Consultation350$ - 0each$ - 0
1029PREVision Consultation8,000$ - 0each$ - 0
1030POSTNon-Psychiatric Level I Consultation (1-15 pages)40$ - 0each$ - 0
1031POSTNon-Psychiatric Level II Consultation (16-30 pages)40$ - 0each$ - 0
1032POSTNon-Psychiatric Level III Consultation (31 and over pages)40$ - 0each$ - 0
Psychiatric Specialist Consultation
1033PREPhysician legal consult/testimony1$ - 0hour$ - 0
1034PREIME physician legal consult/testimony1$ - 0each$ - 0
1035PREMental Health Screening Consultation10,000$ - 0each$ - 0
1036PREPsychiatric Level I Consultation100$ - 0each$ - 0
1037PREPsychiatric Level II Consultation5$ - 0each$ - 0
1038PREPsychiatric Level III Consultation5$ - 0each$ - 0
1039PREPsychiatric Level IV Consultation5$ - 0each$ - 0
1040POSTPsychiatric Level I Consultation (1 - 50 pages)25$ - 0each$ - 0
1041POSTPsychiatric Level II Consultation (51 - 100 pages)25$ - 0each$ - 0
1042POSTPsychiatric Level III Consultation (101 - 300 pages)25$ - 0each$ - 0
1043POSTPsychiatric Level IV Consultation (301 - 500 pages)7$ - 0each$ - 0
1044POSTPsychiatric Level V Consultation (501 - 700 pages)3$ - 0each$ - 0
1045POSTPsychiatric Level VI Consultation (701 - 900 pages)3$ - 0each$ - 0
1046POSTPsychiatric Level VII Consultation (901 - 1100 pages)3$ - 0each$ - 0
1047POSTPsychiatric Level VIII Consultation (1101 - 1300 pages)3$ - 0each$ - 0
1048POSTPsychiatric Level IX Consultation (1301 - 1400 pages)3$ - 0each$ - 0
1049POSTPsychiatric Level X Consultation (1401 to 1500 pages)3$ - 0each$ - 0
1050POSTPhysician legal consult/testimony10$ - 0each$ - 0
1051POSTIME physician legal consult/testimony (per physican / case)5$ - 0each$ - 0
Fitness Test Services
1052PREPre-employment Fitness Test - BPA55,000$ - 0each$ - 0
1053PREPre-employment Fitness Test - CBPO55,000$ - 0each$ - 0
1054PREPre-employment Fitness Test - AMO5,000$ - 0each$ - 0
1055PREPre-employment Fitness Test Overseas - BPA1$ - 0each$ - 0
1056PREPre-employment Fitness Test Overseas - CBPO1$ - 0each$ - 0
1057PREPre-employment Fitness Test Overseas - AMO1$ - 0each$ - 0
Drug Program Services [Employee Drug Testing, Collection staff and HHS clinics, collection kits and shipping, Laboratory, and MRO services]
NOTE: All costs associated with Drug Testing will be rolled into CLINs under the circumstances for Random, Reasonable Suspicion, Post Accident and Return-to Duty /follow up. Specimen Testing Services include: Scheduling, Collection Supplies, On and Off-site specimen collection, Quality Control and Training, Data, Monthly Statistical Reports, Corrective Action Report, Status Briefings, Next Day Delivery Service (One Way), and Courier Services, Laboratory, MRO services and split specimen transfers .
1058PREBlind Sample (Collection and shipping supplies, Lab and MRO)180$ - 0each$ - 0
1059PREMRO Meeting and Consultations1$ - 0hour$ - 0
1060PREMRO Expert Testimony1$ - 0hour$ - 0
1061PRELaboratory Director Expert Testimony1$ - 0hour$ - 0
1062PREPre-employment Drug Test - all positions115,000$ - 0each$ - 0
1063PREPre-employment Onsite - all positions1$ - 0each$ - 0
1064PREPre-employment Modified Onsites - all positions1$ - 0each$ - 0
1065PREPre-employment Overseas Drug Test - all positions1$ - 0each$ - 0
1066PREPre-Employment Positive (without Litigation package)1,000$ - 0each$ - 0
1067PRESplit Specimen TX to the HHS Labs (TX, GC/MS, MRO)1,000$ - 0each$ - 0
1068PRELitigation Package1$ - 0each$ - 0
1069POSTFFD Negative drug test10$ - 0each$ - 0
1070POSTFFD Positive drug test3$ - 0each$ - 0
1071POSTEmployee Random Drug Test (20% of Drug Testing Positions12,200$ - 0each$ - 0
1072POSTReasonable Suspicion35$ - 0each$ - 0
1073POSTPost Accident (unsafe practice)20$ - 0each$ - 0
1074POSTReturn-to-duty/follow-up20$ - 0each$ - 0
1075POSTPositive Drug Test Results (Includes Litigation package)40$ - 0each$ - 0
1076POSTSplit Specimen TX to the HHS Labs(TX, GC/MS, MRO & Litigation package)30$ - 0each$ - 0
1077POSTBlind Sample (Collection and shipping supplies, Lab and MRO)300$ - 0each$ - 0
1078POSTMRO Meeting and Consultations15$ - 0Hours$ - 0
1079POSTMRO Expert Testimony36$ - 0Hours$ - 0
1080POSTLaboratory Director Expert Testimony10$ - 0Hours$ - 0
1081POSTMRO and Laboratory Travel4$ - 0each$ - 0
Additional Medical tests
1082POSTChest X-Ray (single view)5$ - 0each$ - 0
1083POSTChest X-Ray (PA and Lateral)5$ - 0each$ - 0
1084POSTX-Ray (general)10$ - 0each$ - 0
1085POSTTB Skin Test (with chest x-ray if indicated)5$ - 0each$ - 0
1086POSTAudiometry5$ - 0each$ - 0
1087POSTLab Profile: CBC with differential, CHEM profile, Urinalysis5$ - 0each$ - 0
1088POSTResting EKG with interpretation15$ - 0each$ - 0
1089POSTVisual Acuity (Corrected and uncorrected, near and distance)15$ - 0each$ - 0
1090POSTVital Signs5$ - 0each$ - 0
1091POSTThyroid Stimulating Hormone (TSH) w/Reflex Free T460$ - 0each$ - 0
1092POSTHemoglobin A1C (HgBA1C)30$ - 0each$ - 0
1093POSTBlood Glucose30$ - 0each$ - 0
1094POSTBlood Lead Level5$ - 0each$ - 0
1095POSTCardiac Risk Profile/Lipid Panel30$ - 0each$ - 0
1096POSTColor Vision Assessment5$ - 0each$ - 0
1097POSTMaximal Stress EKG with MD interpretation5$ - 0each$ - 0
1098POSTPeripheral Vision and Visual Depth Perception5$ - 0each$ - 0
1099POSTProtoporphyrin, Zinc (ZPP) Blood Test5$ - 0each$ - 0
1100POSTResting 12 Lead EKG with MD Interpretation5$ - 0each$ - 0
1101POSTSpirometry (FVC%, FEV1, FEV1/FVC%)5$ - 0each$ - 0
1102POSTBlood Alcohol Test5$ - 0each$ - 0
1103POSTExercise Stress Echo5$ - 0each$ - 0
1104POSTEchocardiogram5$ - 0each$ - 0
1105POSTSleep study5$ - 0each$ - 0
1106POSTFunctional capacity Evaluation (FCE) with report10$ - 0each$ - 0
1107POSTFolate5$ - 0each$ - 0
1108POSTVitamin B-125$ - 0each$ - 0
1109POSTProthrombin Time with INR5$ - 0each$ - 0
1110POSTPartial Thromboplastin Time, Activated5$ - 0each$ - 0
1111POSTMiscellaneous IME Tests (NTE)20$ - 0each$ - 0
Travel
1112POST/PREMedical Services Travel (i.e. Meetings)1$ 10,000.00each$ 10,000.00
1113POST/PREMRO and Laboratory Travel1$ 10,000.00each$ 10,000.00
Development of Medical Standards and Clinical Policy Consultation
1114POSTDevelopment of Vision Standards (CBPO, AMO Positions)2$ - 0each$ - 0
1115POSTDevelopment of Hearing Standards (CBPO, AMO Positions)2$ - 0each$ - 0
1116POSTClinical Consultation for Policy Determinations (e.g., use of insulin pumps; post-operative refractive surgical procedures). Hourly rate = NTE $300/hr. for 4 hours Varies by Clinical Specialty and nature of inquiry4$ - 0each$ - 0
Ordering Period 1 Total Extended Value$ 20,000.00

Comprehensive Health Services, LLC U.S. Customs and Border Protection

Use or disclosure of data contained on this sheet is subject to the restrictions on the title page of this proposal.

OP2

Ordering Period 270B06C26R00000017- Ordering Period 2
Instructions for Completing the Pricing Schedule

On the other worksheets, offerors must provide unit pricing for numbered CLINs listed. All unit prices should be entered in the designated column for each CLIN.

Travel Reimbursement: Travel costs will be reimbursed in accordance with Federal Travel Regulations. The values for travel are “Not-To-Exceed” (NTE) amounts and have already been entered in the pricing schedule. Offerors shall not modify these NTE values. Vendors shall offer unit pricing for all highlighted cells, even if there is a zero entered for quantity.

IDIQ Contract Structure: This solicitation is for an Indefinite Delivery/Indefinite Quantity (IDIQ) contract. The quantities provided in the pricing schedule are estimates only and are for evaluation purposes.

Actual orders will be placed using fixed unit price line items of funding for any combination of CLINs, based on the Government’s needs.

Order Placement: Orders may be placed for any CLIN(s) listed in the schedule, in any quantity, at the fixed unit price proposed.

Offerors are not guaranteed any minimum quantity and should be prepared to fulfill orders as required.

General Notes: Any cancellation fees shall be considered a cost of doing business and are not separately priced. Offerors must incorporate such costs into their unit pricing.

Program CategoryDescription_Unit PriceExtended Value
Est QTYUnit
CLINMedical Services
Medical Examinations (IME: Cost includes evaluation, physician review, cancellation, and all administrative fees.)
2001PREIME (including physician review)1$ - 0each$ - 0
2002PRENo show fee IME (day of appointment)1$ - 0each$ - 0
2003PREPsychiatric IME (including physician review)1$ - 0each$ - 0
2004PREPre-employment medical exam - all positions115,000$ - 0each$ - 0
2005PREPre-employment medical exam/drug test combination1$ - 0each$ - 0
2006PREPre-employment fitness test/drug test combination1$ - 0each$ - 0
2007PREPre-employment medical exam/fitness test combination1$ - 0each$ - 0
2008PREPre-employment medical exam/fitness test/drug test combination1$ - 0each$ - 0
2009PREPre-employment Overseas Medical Examination1$ - 0each$ - 0
2010POSTEmployee medical examination (including physician review)130$ - 0each$ - 0
2011POSTNo show fee for employee medical examination8$ - 0each$ - 0
2012POSTIME (including physician review)75$ - 0each$ - 0
2013POSTNo show fee (day of appointment)10$ - 0Lot$ - 0
2014POSTPsychiatric IME75$ - 0each$ - 0
2015POSTMedical Hardship/Medical Reassignment I100$ - 0each$ - 0
2016POSTMedical Hardship/Medical Reassignment II100$ - 0each$ - 0
Non-Psychiatric Consultation
2017PRENon-Psychiatric Consultation Level I5,000$ - 0each$ - 0
2018PRENon-Psychiatric Consultation Level 2-1 (100 pages or less)50$ - 0each$ - 0
2019PRENon-Psychiatric Consultation Level 2-2 (101-200 pages)100$ - 0each$ - 0
2020PRENon-Psychiatric Consultation Level 2-3 (201-300 pages)100$ - 0each$ - 0
2021PRENon-Psychiatric Consultation Level 2-4 (301-400 pages)100$ - 0each$ - 0
2022PRENon-Psychiatric Consultation Level 2-5 (401-500 pages)100$ - 0each$ - 0
2023PRENon-Psychiatric Consultation Level 2-6 (501-600 pages)40$ - 0each$ - 0
2024PRENon-Psychiatric Consultation Level 2-7 (601-700 pages)40$ - 0each$ - 0
2025PRENon-Psychiatric Consultation Level 2-8 (701-800 pages)40$ - 0each$ - 0
2026PRENon-Psychiatric Consultation Level 2-9 (801-900 pages)5$ - 0each$ - 0
2027PRENon-Psychiatric Consultation Level 2-10 (901-1000 pages)5$ - 0each$ - 0
2028PRENon-Psychiatric Level III Specialist Consultation350$ - 0each$ - 0
2029PREVision Consultation8,000$ - 0each$ - 0
2030POSTNon-Psychiatric Level I Consultation (1-15 pages)40$ - 0each$ - 0
2031POSTNon-Psychiatric Level II Consultation (16-30 pages)40$ - 0each$ - 0
2032POSTNon-Psychiatric Level III Consultation (31 and over pages)40$ - 0each$ - 0
Psychiatric Specialist Consultation
2033PREPhysician legal consult/testimony1$ - 0hour$ - 0
2034PREIME physician legal consult/testimony1$ - 0each$ - 0
2035PREMental Health Screening Consultation10,000$ - 0each$ - 0
2036PREPsychiatric Level I Consultation100$ - 0each$ - 0
2037PREPsychiatric Level II Consultation5$ - 0each$ - 0
2038PREPsychiatric Level III Consultation5$ - 0each$ - 0
2039PREPsychiatric Level IV Consultation5$ - 0each$ - 0
2040POSTPsychiatric Level I Consultation (1 - 50 pages)25$ - 0each$ - 0
2041POSTPsychiatric Level II Consultation (51 - 100 pages)25$ - 0each$ - 0
2042POSTPsychiatric Level III Consultation (101 - 300 pages)25$ - 0each$ - 0
2043POSTPsychiatric Level IV Consultation (301 - 500 pages)7$ - 0each$ - 0
2044POSTPsychiatric Level V Consultation (501 - 700 pages)3$ - 0each$ - 0
2045POSTPsychiatric Level VI Consultation (701 - 900 pages)3$ - 0each$ - 0
2046POSTPsychiatric Level VII Consultation (901 - 1100 pages)3$ - 0each$ - 0
2047POSTPsychiatric Level VIII Consultation (1101 - 1300 pages)3$ - 0each$ - 0
2048POSTPsychiatric Level IX Consultation (1301 - 1400 pages)3$ - 0each$ - 0
2049POSTPsychiatric Level X Consultation (1401 to 1500 pages)3$ - 0each$ - 0
2050POSTPhysician legal consult/testimony10$ - 0each$ - 0
2051POSTIME physician legal consult/testimony (per physican / case)5$ - 0each$ - 0
Fitness Test Services
2052PREPre-employment Fitness Test - BPA55,000$ - 0each$ - 0
2053PREPre-employment Fitness Test - CBPO55,000$ - 0each$ - 0
2054PREPre-employment Fitness Test - AMO5,000$ - 0each$ - 0
2055PREPre-employment Fitness Test Overseas - BPA1$ - 0each$ - 0
2056PREPre-employment Fitness Test Overseas - CBPO1$ - 0each$ - 0
2057PREPre-employment Fitness Test Overseas - AMO1$ - 0each$ - 0
Drug Program Services [Employee Drug Testing, Collection staff and HHS clinics, collection kits and shipping, Laboratory, and MRO services]
NOTE: All costs associated with Drug Testing will be rolled into CLINs under the circumstances for Random, Reasonable Suspicion, Post Accident and Return-to Duty /follow up. Specimen Testing Services include: Scheduling, Collection Supplies, On and Off-site specimen collection, Quality Control and Training, Data, Monthly Statistical Reports, Corrective Action Report, Status Briefings, Next Day Delivery Service (One Way), and Courier Services, Laboratory, MRO services and split specimen transfers .
2058PREBlind Sample (Collection and shipping supplies, Lab and MRO)180$ - 0each$ - 0
2059PREMRO Meeting and Consultations1$ - 0hour$ - 0
2060PREMRO Expert Testimony1$ - 0hour$ - 0
2061PRELaboratory Director Expert Testimony1$ - 0hour$ - 0
2062PREPre-employment Drug Test - all positions115,000$ - 0each$ - 0
2063PREPre-employment Onsite - all positions1$ - 0each$ - 0
2064PREPre-employment Modified Onsites - all positions1$ - 0each$ - 0
2065PREPre-employment Overseas Drug Test - all positions1$ - 0each$ - 0
2066PREPre-Employment Positive (without Litigation package)1,000$ - 0each$ - 0
2067PRESplit Specimen TX to the HHS Labs (TX, GC/MS, MRO)1,000$ - 0each$ - 0
2068PRELitigation Package1$ - 0each$ - 0
2069POSTFFD Negative drug test10$ - 0each$ - 0
2070POSTFFD Positive drug test3$ - 0each$ - 0
2071POSTEmployee Random Drug Test (20% of Drug Testing Positions12,200$ - 0each$ - 0
2072POSTReasonable Suspicion35$ - 0each$ - 0
2073POSTPost Accident (unsafe practice)20$ - 0each$ - 0
2074POSTReturn-to-duty/follow-up20$ - 0each$ - 0
2075POSTPositive Drug Test Results (Includes Litigation package)40$ - 0each$ - 0
2076POSTSplit Specimen TX to the HHS Labs(TX, GC/MS, MRO & Litigation package)30$ - 0each$ - 0
2077POSTBlind Sample (Collection and shipping supplies, Lab and MRO)300$ - 0each$ - 0
2078POSTMRO Meeting and Consultations15$ - 0Hours$ - 0
2079POSTMRO Expert Testimony36$ - 0Hours$ - 0
2080POSTLaboratory Director Expert Testimony10$ - 0Hours$ - 0
2081POSTMRO and Laboratory Travel4$ - 0each$ - 0
Additional Medical tests
2082POSTChest X-Ray (single view)5$ - 0each$ - 0
2083POSTChest X-Ray (PA and Lateral)5$ - 0each$ - 0
2084POSTX-Ray (general)10$ - 0each$ - 0
2085POSTTB Skin Test (with chest x-ray if indicated)5$ - 0each$ - 0
2086POSTAudiometry5$ - 0each$ - 0
2087POSTLab Profile: CBC with differential, CHEM profile, Urinalysis5$ - 0each$ - 0
2088POSTResting EKG with interpretation15$ - 0each$ - 0
2089POSTVisual Acuity (Corrected and uncorrected, near and distance)15$ - 0each$ - 0
2090POSTVital Signs5$ - 0each$ - 0
2091POSTThyroid Stimulating Hormone (TSH) w/Reflex Free T460$ - 0each$ - 0
2092POSTHemoglobin A1C (HgBA1C)30$ - 0each$ - 0
2093POSTBlood Glucose30$ - 0each$ - 0
2094POSTBlood Lead Level5$ - 0each$ - 0
2095POSTCardiac Risk Profile/Lipid Panel30$ - 0each$ - 0
2096POSTColor Vision Assessment5$ - 0each$ - 0
2097POSTMaximal Stress EKG with MD interpretation5$ - 0each$ - 0
2098POSTPeripheral Vision and Visual Depth Perception5$ - 0each$ - 0
2099POSTProtoporphyrin, Zinc (ZPP) Blood Test5$ - 0each$ - 0
2100POSTResting 12 Lead EKG with MD Interpretation5$ - 0each$ - 0
2101POSTSpirometry (FVC%, FEV1, FEV1/FVC%)5$ - 0each$ - 0
2102POSTBlood Alcohol Test5$ - 0each$ - 0
2103POSTExercise Stress Echo5$ - 0each$ - 0
2104POSTEchocardiogram5$ - 0each$ - 0
2105POSTSleep study5$ - 0each$ - 0
2106POSTFunctional capacity Evaluation (FCE) with report10$ - 0each$ - 0
2107POSTFolate5$ - 0each$ - 0
2108POSTVitamin B-125$ - 0each$ - 0
2109POSTProthrombin Time with INR5$ - 0each$ - 0
2110POSTPartial Thromboplastin Time, Activated5$ - 0each$ - 0
2111POSTMiscellaneous IME Tests (NTE)20$ - 0each$ - 0
Travel
2112POST/PREMedical Services Travel (i.e. Meetings)1$ 10,000.00each$ 10,000.00
2113POST/PREMRO and Laboratory Travel1$ 10,000.00each$ 10,000.00
Development of Medical Standards and Clinical Policy Consultation
2114POSTDevelopment of Vision Standards (CBPO, AMO Positions)2$ - 0each$ - 0
2115POSTDevelopment of Hearing Standards (CBPO, AMO Positions)2$ - 0each$ - 0
2116POSTClinical Consultation for Policy Determinations (e.g., use of insulin pumps; post-operative refractive surgical procedures). Hourly rate = NTE $300/hr. for 4 hours Varies by Clinical Specialty and nature of inquiry4$ - 0each$ - 0
Ordering Period 2 Total Extended Value$ 20,000.00

Comprehensive Health Services, LLC U.S. Customs and Border Protection

Use or disclosure of data contained on this sheet is subject to the restrictions on the title page of this proposal.

OP3

Ordering Period 370B06C26R00000017- Ordering Period 3
Instructions for Completing the Pricing Schedule

On the other worksheets, offerors must provide unit pricing for numbered CLINs listed. All unit prices should be entered in the designated column for each CLIN.

Travel Reimbursement: Travel costs will be reimbursed in accordance with Federal Travel Regulations. The values for travel are “Not-To-Exceed” (NTE) amounts and have already been entered in the pricing schedule. Offerors shall not modify these NTE values. Vendors shall offer unit pricing for all highlighted cells, even if there is a zero entered for quantity.

IDIQ Contract Structure: This solicitation is for an Indefinite Delivery/Indefinite Quantity (IDIQ) contract. The quantities provided in the pricing schedule are estimates only and are for evaluation purposes.

Actual orders will be placed using fixed unit price line items of funding for any combination of CLINs, based on the Government’s needs.

Order Placement: Orders may be placed for any CLIN(s) listed in the schedule, in any quantity, at the fixed unit price proposed.

Offerors are not guaranteed any minimum quantity and should be prepared to fulfill orders as required.

General Notes: Any cancellation fees shall be considered a cost of doing business and are not separately priced. Offerors must incorporate such costs into their unit pricing.

Program CategoryDescription_Unit PriceExtended Value
Est QTYUnit
CLINMedical Services
Medical Examinations (IME: Cost includes evaluation, physician review, cancellation, and all administrative fees.)
3001PREIME (including physician review)1$ - 0each$ - 0
3002PRENo show fee IME (day of appointment)1$ - 0each$ - 0
3003PREPsychiatric IME (including physician review)1$ - 0each$ - 0
3004PREPre-employment medical exam - all positions115,000$ - 0each$ - 0
3005PREPre-employment medical exam/drug test combination1$ - 0each$ - 0
3006PREPre-employment fitness test/drug test combination1$ - 0each$ - 0
3007PREPre-employment medical exam/fitness test combination1$ - 0each$ - 0
3008PREPre-employment medical exam/fitness test/drug test combination1$ - 0each$ - 0
3009PREPre-employment Overseas Medical Examination1$ - 0each$ - 0
3010POSTEmployee medical examination (including physician review)130$ - 0each$ - 0
3011POSTNo show fee for employee medical examination8$ - 0each$ - 0
3012POSTIME (including physician review)75$ - 0each$ - 0
3013POSTNo show fee (day of appointment)10$ - 0Lot$ - 0
3014POSTPsychiatric IME75$ - 0each$ - 0
3015POSTMedical Hardship/Medical Reassignment I100$ - 0each$ - 0
3016POSTMedical Hardship/Medical Reassignment II100$ - 0each$ - 0
Non-Psychiatric Consultation
3017PRENon-Psychiatric Consultation Level I5,000$ - 0each$ - 0
3018PRENon-Psychiatric Consultation Level 2-1 (100 pages or less)50$ - 0each$ - 0
3019PRENon-Psychiatric Consultation Level 2-2 (101-200 pages)100$ - 0each$ - 0
3020PRENon-Psychiatric Consultation Level 2-3 (201-300 pages)100$ - 0each$ - 0
3021PRENon-Psychiatric Consultation Level 2-4 (301-400 pages)100$ - 0each$ - 0
3022PRENon-Psychiatric Consultation Level 2-5 (401-500 pages)100$ - 0each$ - 0
3023PRENon-Psychiatric Consultation Level 2-6 (501-600 pages)40$ - 0each$ - 0
3024PRENon-Psychiatric Consultation Level 2-7 (601-700 pages)40$ - 0each$ - 0
3025PRENon-Psychiatric Consultation Level 2-8 (701-800 pages)40$ - 0each$ - 0
3026PRENon-Psychiatric Consultation Level 2-9 (801-900 pages)5$ - 0each$ - 0
3027PRENon-Psychiatric Consultation Level 2-10 (901-1000 pages)5$ - 0each$ - 0
3028PRENon-Psychiatric Level III Specialist Consultation350$ - 0each$ - 0
3029PREVision Consultation8,000$ - 0each$ - 0
3030POSTNon-Psychiatric Level I Consultation (1-15 pages)40$ - 0each$ - 0
3031POSTNon-Psychiatric Level II Consultation (16-30 pages)40$ - 0each$ - 0
3032POSTNon-Psychiatric Level III Consultation (31 and over pages)40$ - 0each$ - 0
Psychiatric Specialist Consultation
3033PREPhysician legal consult/testimony1$ - 0hour$ - 0
3034PREIME physician legal consult/testimony1$ - 0each$ - 0
3035PREMental Health Screening Consultation10,000$ - 0each$ - 0
3036PREPsychiatric Level I Consultation100$ - 0each$ - 0
3037PREPsychiatric Level II Consultation5$ - 0each$ - 0
3038PREPsychiatric Level III Consultation5$ - 0each$ - 0
3039PREPsychiatric Level IV Consultation5$ - 0each$ - 0
3040POSTPsychiatric Level I Consultation (1 - 50 pages)25$ - 0each$ - 0
3041POSTPsychiatric Level II Consultation (51 - 100 pages)25$ - 0each$ - 0
3042POSTPsychiatric Level III Consultation (101 - 300 pages)25$ - 0each$ - 0
3043POSTPsychiatric Level IV Consultation (301 - 500 pages)7$ - 0each$ - 0
3044POSTPsychiatric Level V Consultation (501 - 700 pages)3$ - 0each$ - 0
3045POSTPsychiatric Level VI Consultation (701 - 900 pages)3$ - 0each$ - 0
3046POSTPsychiatric Level VII Consultation (901 - 1100 pages)3$ - 0each$ - 0
3047POSTPsychiatric Level VIII Consultation (1101 - 1300 pages)3$ - 0each$ - 0
3048POSTPsychiatric Level IX Consultation (1301 - 1400 pages)3$ - 0each$ - 0
3049POSTPsychiatric Level X Consultation (1401 to 1500 pages)3$ - 0each$ - 0
3050POSTPhysician legal consult/testimony10$ - 0each$ - 0
3051POSTIME physician legal consult/testimony (per physican / case)5$ - 0each$ - 0
Fitness Test Services
3052PREPre-employment Fitness Test - BPA55,000$ - 0each$ - 0
3053PREPre-employment Fitness Test - CBPO55,000$ - 0each$ - 0
3054PREPre-employment Fitness Test - AMO5,000$ - 0each$ - 0
3055PREPre-employment Fitness Test Overseas - BPA1$ - 0each$ - 0
3056PREPre-employment Fitness Test Overseas - CBPO1$ - 0each$ - 0
3057PREPre-employment Fitness Test Overseas - AMO1$ - 0each$ - 0
Drug Program Services [Employee Drug Testing, Collection staff and HHS clinics, collection kits and shipping, Laboratory, and MRO services]
NOTE: All costs associated with Drug Testing will be rolled into CLINs under the circumstances for Random, Reasonable Suspicion, Post Accident and Return-to Duty /follow up. Specimen Testing Services include: Scheduling, Collection Supplies, On and Off-site specimen collection, Quality Control and Training, Data, Monthly Statistical Reports, Corrective Action Report, Status Briefings, Next Day Delivery Service (One Way), and Courier Services, Laboratory, MRO services and split specimen transfers .
3058PREBlind Sample (Collection and shipping supplies, Lab and MRO)180$ - 0each$ - 0
3059PREMRO Meeting and Consultations1$ - 0hour$ - 0
3060PREMRO Expert Testimony1$ - 0hour$ - 0
3061PRELaboratory Director Expert Testimony1$ - 0hour$ - 0
3062PREPre-employment Drug Test - all positions115,000$ - 0each$ - 0
3063PREPre-employment Onsite - all positions1$ - 0each$ - 0
3064PREPre-employment Modified Onsites - all positions1$ - 0each$ - 0
3065PREPre-employment Overseas Drug Test - all positions1$ - 0each$ - 0
3066PREPre-Employment Positive (without Litigation package)1,000$ - 0each$ - 0
3067PRESplit Specimen TX to the HHS Labs (TX, GC/MS, MRO)1,000$ - 0each$ - 0
3068PRELitigation Package1$ - 0each$ - 0
3069POSTFFD Negative drug test10$ - 0each$ - 0
3070POSTFFD Positive drug test3$ - 0each$ - 0
3071POSTEmployee Random Drug Test (20% of Drug Testing Positions12,200$ - 0each$ - 0
3072POSTReasonable Suspicion35$ - 0each$ - 0
3073POSTPost Accident (unsafe practice)20$ - 0each$ - 0
3074POSTReturn-to-duty/follow-up20$ - 0each$ - 0
3075POSTPositive Drug Test Results (Includes Litigation package)40$ - 0each$ - 0
3076POSTSplit Specimen TX to the HHS Labs(TX, GC/MS, MRO & Litigation package)30$ - 0each$ - 0
3077POSTBlind Sample (Collection and shipping supplies, Lab and MRO)300$ - 0each$ - 0
3078POSTMRO Meeting and Consultations15$ - 0Hours$ - 0
3079POSTMRO Expert Testimony36$ - 0Hours$ - 0
3080POSTLaboratory Director Expert Testimony10$ - 0Hours$ - 0
3081POSTMRO and Laboratory Travel4$ - 0each$ - 0
Additional Medical tests
3082POSTChest X-Ray (single view)5$ - 0each$ - 0
3083POSTChest X-Ray (PA and Lateral)5$ - 0each$ - 0
3084POSTX-Ray (general)10$ - 0each$ - 0
3085POSTTB Skin Test (with chest x-ray if indicated)5$ - 0each$ - 0
3086POSTAudiometry5$ - 0each$ - 0
3087POSTLab Profile: CBC with differential, CHEM profile, Urinalysis5$ - 0each$ - 0
3088POSTResting EKG with interpretation15$ - 0each$ - 0
3089POSTVisual Acuity (Corrected and uncorrected, near and distance)15$ - 0each$ - 0
3090POSTVital Signs5$ - 0each$ - 0
3091POSTThyroid Stimulating Hormone (TSH) w/Reflex Free T460$ - 0each$ - 0
3092POSTHemoglobin A1C (HgBA1C)30$ - 0each$ - 0
3093POSTBlood Glucose30$ - 0each$ - 0
3094POSTBlood Lead Level5$ - 0each$ - 0
3095POSTCardiac Risk Profile/Lipid Panel30$ - 0each$ - 0
3096POSTColor Vision Assessment5$ - 0each$ - 0
3097POSTMaximal Stress EKG with MD interpretation5$ - 0each$ - 0
3098POSTPeripheral Vision and Visual Depth Perception5$ - 0each$ - 0
3099POSTProtoporphyrin, Zinc (ZPP) Blood Test5$ - 0each$ - 0
3100POSTResting 12 Lead EKG with MD Interpretation5$ - 0each$ - 0
3101POSTSpirometry (FVC%, FEV1, FEV1/FVC%)5$ - 0each$ - 0
3102POSTBlood Alcohol Test5$ - 0each$ - 0
3103POSTExercise Stress Echo5$ - 0each$ - 0
3104POSTEchocardiogram5$ - 0each$ - 0
3105POSTSleep study5$ - 0each$ - 0
3106POSTFunctional capacity Evaluation (FCE) with report10$ - 0each$ - 0
3107POSTFolate5$ - 0each$ - 0
3108POSTVitamin B-125$ - 0each$ - 0
3109POSTProthrombin Time with INR5$ - 0each$ - 0
3110POSTPartial Thromboplastin Time, Activated5$ - 0each$ - 0
3111POSTMiscellaneous IME Tests (NTE)20$ - 0each$ - 0
Travel
3112POST/PREMedical Services Travel (i.e. Meetings)1$ 10,000.00each$ 10,000.00
3113POST/PREMRO and Laboratory Travel1$ 10,000.00each$ 10,000.00
Development of Medical Standards and Clinical Policy Consultation
3114POSTDevelopment of Vision Standards (CBPO, AMO Positions)2$ - 0each$ - 0
3115POSTDevelopment of Hearing Standards (CBPO, AMO Positions)2$ - 0each$ - 0
3116POSTClinical Consultation for Policy Determinations (e.g., use of insulin pumps; post-operative refractive surgical procedures). Hourly rate = NTE $300/hr. for 4 hours Varies by Clinical Specialty and nature of inquiry4$ - 0each$ - 0
Ordering Period 3 Total Extended Value$ 20,000.00

Comprehensive Health Services, LLC U.S. Customs and Border Protection

Use or disclosure of data contained on this sheet is subject to the restrictions on the title page of this proposal.

OP4

Ordering Period 470B06C26R00000017- Ordering Period 4
Instructions for Completing the Pricing Schedule

On the other worksheets, offerors must provide unit pricing for numbered CLINs listed. All unit prices should be entered in the designated column for each CLIN.

Travel Reimbursement: Travel costs will be reimbursed in accordance with Federal Travel Regulations. The values for travel are “Not-To-Exceed” (NTE) amounts and have already been entered in the pricing schedule. Offerors shall not modify these NTE values. Vendors shall offer unit pricing for all highlighted cells, even if there is a zero entered for quantity.

IDIQ Contract Structure: This solicitation is for an Indefinite Delivery/Indefinite Quantity (IDIQ) contract. The quantities provided in the pricing schedule are estimates only and are for evaluation purposes.

Actual orders will be placed using fixed unit price line items of funding for any combination of CLINs, based on the Government’s needs.

Order Placement: Orders may be placed for any CLIN(s) listed in the schedule, in any quantity, at the fixed unit price proposed.

Offerors are not guaranteed any minimum quantity and should be prepared to fulfill orders as required.

General Notes: Any cancellation fees shall be considered a cost of doing business and are not separately priced. Offerors must incorporate such costs into their unit pricing.

Program CategoryDescription_Unit PriceExtended Value
Est QTYUnit
CLINMedical Services
Medical Examinations (IME: Cost includes evaluation, physician review, cancellation, and all administrative fees.)
4001PREIME (including physician review)1$ - 0each$ - 0
4002PRENo show fee IME (day of appointment)1$ - 0each$ - 0
4003PREPsychiatric IME (including physician review)1$ - 0each$ - 0
4004PREPre-employment medical exam - all positions115,000$ - 0each$ - 0
4005PREPre-employment medical exam/drug test combination1$ - 0each$ - 0
4006PREPre-employment fitness test/drug test combination1$ - 0each$ - 0
4007PREPre-employment medical exam/fitness test combination1$ - 0each$ - 0
4008PREPre-employment medical exam/fitness test/drug test combination1$ - 0each$ - 0
4009PREPre-employment Overseas Medical Examination1$ - 0each$ - 0
4010POSTEmployee medical examination (including physician review)130$ - 0each$ - 0
4011POSTNo show fee for employee medical examination8$ - 0each$ - 0
4012POSTIME (including physician review)75$ - 0each$ - 0
4013POSTNo show fee (day of appointment)10$ - 0Lot$ - 0
4014POSTPsychiatric IME75$ - 0each$ - 0
4015POSTMedical Hardship/Medical Reassignment I100$ - 0each$ - 0
4016POSTMedical Hardship/Medical Reassignment II100$ - 0each$ - 0
Non-Psychiatric Consultation
4017PRENon-Psychiatric Consultation Level I5,000$ - 0each$ - 0
4018PRENon-Psychiatric Consultation Level 2-1 (100 pages or less)50$ - 0each$ - 0
4019PRENon-Psychiatric Consultation Level 2-2 (101-200 pages)100$ - 0each$ - 0
4020PRENon-Psychiatric Consultation Level 2-3 (201-300 pages)100$ - 0each$ - 0
4021PRENon-Psychiatric Consultation Level 2-4 (301-400 pages)100$ - 0each$ - 0
4022PRENon-Psychiatric Consultation Level 2-5 (401-500 pages)100$ - 0each$ - 0
4023PRENon-Psychiatric Consultation Level 2-6 (501-600 pages)40$ - 0each$ - 0
4024PRENon-Psychiatric Consultation Level 2-7 (601-700 pages)40$ - 0each$ - 0
4025PRENon-Psychiatric Consultation Level 2-8 (701-800 pages)40$ - 0each$ - 0
4026PRENon-Psychiatric Consultation Level 2-9 (801-900 pages)5$ - 0each$ - 0
4027PRENon-Psychiatric Consultation Level 2-10 (901-1000 pages)5$ - 0each$ - 0
4028PRENon-Psychiatric Level III Specialist Consultation350$ - 0each$ - 0
4029PREVision Consultation8,000$ - 0each$ - 0
4030POSTNon-Psychiatric Level I Consultation (1-15 pages)40$ - 0each$ - 0
4031POSTNon-Psychiatric Level II Consultation (16-30 pages)40$ - 0each$ - 0
4032POSTNon-Psychiatric Level III Consultation (31 and over pages)40$ - 0each$ - 0
Psychiatric Specialist Consultation
4033PREPhysician legal consult/testimony1$ - 0hour$ - 0
4034PREIME physician legal consult/testimony1$ - 0each$ - 0
4035PREMental Health Screening Consultation10,000$ - 0each$ - 0
4036PREPsychiatric Level I Consultation100$ - 0each$ - 0
4037PREPsychiatric Level II Consultation5$ - 0each$ - 0
4038PREPsychiatric Level III Consultation5$ - 0each$ - 0
4039PREPsychiatric Level IV Consultation5$ - 0each$ - 0
4040POSTPsychiatric Level I Consultation (1 - 50 pages)25$ - 0each$ - 0
4041POSTPsychiatric Level II Consultation (51 - 100 pages)25$ - 0each$ - 0
4042POSTPsychiatric Level III Consultation (101 - 300 pages)25$ - 0each$ - 0
4043POSTPsychiatric Level IV Consultation (301 - 500 pages)7$ - 0each$ - 0
4044POSTPsychiatric Level V Consultation (501 - 700 pages)3$ - 0each$ - 0
4045POSTPsychiatric Level VI Consultation (701 - 900 pages)3$ - 0each$ - 0
4046POSTPsychiatric Level VII Consultation (901 - 1100 pages)3$ - 0each$ - 0
4047POSTPsychiatric Level VIII Consultation (1101 - 1300 pages)3$ - 0each$ - 0
4048POSTPsychiatric Level IX Consultation (1301 - 1400 pages)3$ - 0each$ - 0
4049POSTPsychiatric Level X Consultation (1401 to 1500 pages)3$ - 0each$ - 0
4050POSTPhysician legal consult/testimony10$ - 0each$ - 0
4051POSTIME physician legal consult/testimony (per physican / case)5$ - 0each$ - 0
Fitness Test Services
4052PREPre-employment Fitness Test - BPA55,000$ - 0each$ - 0
4053PREPre-employment Fitness Test - CBPO55,000$ - 0each$ - 0
4054PREPre-employment Fitness Test - AMO5,000$ - 0each$ - 0
4055PREPre-employment Fitness Test Overseas - BPA1$ - 0each$ - 0
4056PREPre-employment Fitness Test Overseas - CBPO1$ - 0each$ - 0
4057PREPre-employment Fitness Test Overseas - AMO1$ - 0each$ - 0
Drug Program Services [Employee Drug Testing, Collection staff and HHS clinics, collection kits and shipping, Laboratory, and MRO services]
NOTE: All costs associated with Drug Testing will be rolled into CLINs under the circumstances for Random, Reasonable Suspicion, Post Accident and Return-to Duty /follow up. Specimen Testing Services include: Scheduling, Collection Supplies, On and Off-site specimen collection, Quality Control and Training, Data, Monthly Statistical Reports, Corrective Action Report, Status Briefings, Next Day Delivery Service (One Way), and Courier Services, Laboratory, MRO services and split specimen transfers .
4058PREBlind Sample (Collection and shipping supplies, Lab and MRO)180$ - 0each$ - 0
4059PREMRO Meeting and Consultations1$ - 0hour$ - 0
4060PREMRO Expert Testimony1$ - 0hour$ - 0
4061PRELaboratory Director Expert Testimony1$ - 0hour$ - 0
4062PREPre-employment Drug Test - all positions115,000$ - 0each$ - 0
4063PREPre-employment Onsite - all positions1$ - 0each$ - 0
4064PREPre-employment Modified Onsites - all positions1$ - 0each$ - 0
4065PREPre-employment Overseas Drug Test - all positions1$ - 0each$ - 0
4066PREPre-Employment Positive (without Litigation package)1,000$ - 0each$ - 0
4067PRESplit Specimen TX to the HHS Labs (TX, GC/MS, MRO)1,000$ - 0each$ - 0
4068PRELitigation Package1$ - 0each$ - 0
4069POSTFFD Negative drug test10$ - 0each$ - 0
4070POSTFFD Positive drug test3$ - 0each$ - 0
4071POSTEmployee Random Drug Test (20% of Drug Testing Positions12,200$ - 0each$ - 0
4072POSTReasonable Suspicion35$ - 0each$ - 0
4073POSTPost Accident (unsafe practice)20$ - 0each$ - 0
4074POSTReturn-to-duty/follow-up20$ - 0each$ - 0
4075POSTPositive Drug Test Results (Includes Litigation package)40$ - 0each$ - 0
4076POSTSplit Specimen TX to the HHS Labs(TX, GC/MS, MRO & Litigation package)30$ - 0each$ - 0
4077POSTBlind Sample (Collection and shipping supplies, Lab and MRO)300$ - 0each$ - 0
4078POSTMRO Meeting and Consultations15$ - 0Hours$ - 0
4079POSTMRO Expert Testimony36$ - 0Hours$ - 0
4080POSTLaboratory Director Expert Testimony10$ - 0Hours$ - 0
4081POSTMRO and Laboratory Travel4$ - 0each$ - 0
Additional Medical tests
4082POSTChest X-Ray (single view)5$ - 0each$ - 0
4083POSTChest X-Ray (PA and Lateral)5$ - 0each$ - 0
4084POSTX-Ray (general)10$ - 0each$ - 0
4085POSTTB Skin Test (with chest x-ray if indicated)5$ - 0each$ - 0
4086POSTAudiometry5$ - 0each$ - 0
4087POSTLab Profile: CBC with differential, CHEM profile, Urinalysis5$ - 0each$ - 0
4088POSTResting EKG with interpretation15$ - 0each$ - 0
4089POSTVisual Acuity (Corrected and uncorrected, near and distance)15$ - 0each$ - 0
4090POSTVital Signs5$ - 0each$ - 0
4091POSTThyroid Stimulating Hormone (TSH) w/Reflex Free T460$ - 0each$ - 0
4092POSTHemoglobin A1C (HgBA1C)30$ - 0each$ - 0
4093POSTBlood Glucose30$ - 0each$ - 0
4094POSTBlood Lead Level5$ - 0each$ - 0
4095POSTCardiac Risk Profile/Lipid Panel30$ - 0each$ - 0
4096POSTColor Vision Assessment5$ - 0each$ - 0
4097POSTMaximal Stress EKG with MD interpretation5$ - 0each$ - 0
4098POSTPeripheral Vision and Visual Depth Perception5$ - 0each$ - 0
4099POSTProtoporphyrin, Zinc (ZPP) Blood Test5$ - 0each$ - 0
4100POSTResting 12 Lead EKG with MD Interpretation5$ - 0each$ - 0
4101POSTSpirometry (FVC%, FEV1, FEV1/FVC%)5$ - 0each$ - 0
4102POSTBlood Alcohol Test5$ - 0each$ - 0
4103POSTExercise Stress Echo5$ - 0each$ - 0
4104POSTEchocardiogram5$ - 0each$ - 0
4105POSTSleep study5$ - 0each$ - 0
4106POSTFunctional capacity Evaluation (FCE) with report10$ - 0each$ - 0
4107POSTFolate5$ - 0each$ - 0
4108POSTVitamin B-125$ - 0each$ - 0
4109POSTProthrombin Time with INR5$ - 0each$ - 0
4110POSTPartial Thromboplastin Time, Activated5$ - 0each$ - 0
4111POSTMiscellaneous IME Tests (NTE)20$ - 0each$ - 0
Travel
4112POST/PREMedical Services Travel (i.e. Meetings)1$ 10,000.00each$ 10,000.00
4113POST/PREMRO and Laboratory Travel1$ 10,000.00each$ 10,000.00
Development of Medical Standards and Clinical Policy Consultation
4114POSTDevelopment of Vision Standards (CBPO, AMO Positions)2$ - 0each$ - 0
4115POSTDevelopment of Hearing Standards (CBPO, AMO Positions)2$ - 0each$ - 0
4116POSTClinical Consultation for Policy Determinations (e.g., use of insulin pumps; post-operative refractive surgical procedures). Hourly rate = NTE $300/hr. for 4 hours Varies by Clinical Specialty and nature of inquiry4$ - 0each$ - 0
Ordering Period 4 Total Extended Value$ 20,000.00

Comprehensive Health Services, LLC U.S. Customs and Border Protection

Use or disclosure of data contained on this sheet is subject to the restrictions on the title page of this proposal.

OP5

Ordering Period 570B06C26R00000017- Ordering Period 5
Instructions for Completing the Pricing Schedule

On the other worksheets, offerors must provide unit pricing for numbered CLINs listed. All unit prices should be entered in the designated column for each CLIN.

Travel Reimbursement: Travel costs will be reimbursed in accordance with Federal Travel Regulations. The values for travel are “Not-To-Exceed” (NTE) amounts and have already been entered in the pricing schedule. Offerors shall not modify these NTE values. Vendors shall offer unit pricing for all highlighted cells, even if there is a zero entered for quantity.

IDIQ Contract Structure: This solicitation is for an Indefinite Delivery/Indefinite Quantity (IDIQ) contract. The quantities provided in the pricing schedule are estimates only and are for evaluation purposes.

Actual orders will be placed using fixed unit price line items of funding for any combination of CLINs, based on the Government’s needs.

Order Placement: Orders may be placed for any CLIN(s) listed in the schedule, in any quantity, at the fixed unit price proposed.

Offerors are not guaranteed any minimum quantity and should be prepared to fulfill orders as required.

General Notes: Any cancellation fees shall be considered a cost of doing business and are not separately priced. Offerors must incorporate such costs into their unit pricing.

Program CategoryDescription_Unit PriceExtended Value
Est QTYUnit
CLINMedical Services
Medical Examinations (IME: Cost includes evaluation, physician review, cancellation, and all administrative fees.)
5001PREIME (including physician review)1$ - 0each$ - 0
5002PRENo show fee IME (day of appointment)1$ - 0each$ - 0
5003PREPsychiatric IME (including physician review)1$ - 0each$ - 0
5004PREPre-employment medical exam - all positions115,000$ - 0each$ - 0
5005PREPre-employment medical exam/drug test combination1$ - 0each$ - 0
5006PREPre-employment fitness test/drug test combination1$ - 0each$ - 0
5007PREPre-employment medical exam/fitness test combination1$ - 0each$ - 0
5008PREPre-employment medical exam/fitness test/drug test combination1$ - 0each$ - 0
5009PREPre-employment Overseas Medical Examination1$ - 0each$ - 0
5010POSTEmployee medical examination (including physician review)130$ - 0each$ - 0
5011POSTNo show fee for employee medical examination8$ - 0each$ - 0
5012POSTIME (including physician review)75$ - 0each$ - 0
5013POSTNo show fee (day of appointment)10$ - 0Lot$ - 0
5014POSTPsychiatric IME75$ - 0each$ - 0
5015POSTMedical Hardship/Medical Reassignment I100$ - 0each$ - 0
5016POSTMedical Hardship/Medical Reassignment II100$ - 0each$ - 0
Non-Psychiatric Consultation
5017PRENon-Psychiatric Consultation Level I5,000$ - 0each$ - 0
5018PRENon-Psychiatric Consultation Level 2-1 (100 pages or less)50$ - 0each$ - 0
5019PRENon-Psychiatric Consultation Level 2-2 (101-200 pages)100$ - 0each$ - 0
5020PRENon-Psychiatric Consultation Level 2-3 (201-300 pages)100$ - 0each$ - 0
5021PRENon-Psychiatric Consultation Level 2-4 (301-400 pages)100$ - 0each$ - 0
5022PRENon-Psychiatric Consultation Level 2-5 (401-500 pages)100$ - 0each$ - 0
5023PRENon-Psychiatric Consultation Level 2-6 (501-600 pages)40$ - 0each$ - 0
5024PRENon-Psychiatric Consultation Level 2-7 (601-700 pages)40$ - 0each$ - 0
5025PRENon-Psychiatric Consultation Level 2-8 (701-800 pages)40$ - 0each$ - 0
5026PRENon-Psychiatric Consultation Level 2-9 (801-900 pages)5$ - 0each$ - 0
5027PRENon-Psychiatric Consultation Level 2-10 (901-1000 pages)5$ - 0each$ - 0
5028PRENon-Psychiatric Level III Specialist Consultation350$ - 0each$ - 0
5029PREVision Consultation8,000$ - 0each$ - 0
5030POSTNon-Psychiatric Level I Consultation (1-15 pages)40$ - 0each$ - 0
5031POSTNon-Psychiatric Level II Consultation (16-30 pages)40$ - 0each$ - 0
5032POSTNon-Psychiatric Level III Consultation (31 and over pages)40$ - 0each$ - 0
Psychiatric Specialist Consultation
5033PREPhysician legal consult/testimony1$ - 0hour$ - 0
5034PREIME physician legal consult/testimony1$ - 0each$ - 0
5035PREMental Health Screening Consultation10,000$ - 0each$ - 0
5036PREPsychiatric Level I Consultation100$ - 0each$ - 0
5037PREPsychiatric Level II Consultation5$ - 0each$ - 0
5038PREPsychiatric Level III Consultation5$ - 0each$ - 0
5039PREPsychiatric Level IV Consultation5$ - 0each$ - 0
5040POSTPsychiatric Level I Consultation (1 - 50 pages)25$ - 0each$ - 0
5041POSTPsychiatric Level II Consultation (51 - 100 pages)25$ - 0each$ - 0
5042POSTPsychiatric Level III Consultation (101 - 300 pages)25$ - 0each$ - 0

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