J.1_Pricing Chart 75P00122R00001.xlsx

XLSX spreadsheet 45 KB Posted Sep 21, 2021

Attached to: OASH Rapid Medical Examinations for Commissioned Corps Accessions
Solicitation number: 75P00122R00001
Issued by: Department of Health and Human Services Office of the Assistant Secretary for Administration

About this file

Written by GovTribe AI · Dec 27, 2023

This pricing chart and solicitation document outline requirements for rapid medical examinations and health assessments to support the U.S. Public Health Service Commissioned Corps. The pricing chart lists over 80 medical examination components and services required on both an individual and recurring basis, including accession exams, retention exams, dental exams, immunizations, lab tests, and deployment health assessments. Estimated annual quantities are provided for budgeting purposes, with unit pricing to be determined by offerors. The three-year base period and four one-year option periods solicitation seeks offers for examination services in multiple locations to support Commissioned Corps operations under the Department of Health and Human Services, with the Office of the Assistant Secretary for Health serving as the requiring activity. Examination support must be provided nationwide, and offerors must demonstrate experience, facilities, and medical staffing to conduct the full scope of physical exams and deployment health activities for Commissioned Corps personnel.

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Other files

File	Type	Posted
J.3 Past PerformanceQuestionnaire.pdf	PDF	Sep 27, 2021
J.4_Contractor Non Disclosure Agreement.pdf	PDF	Sep 27, 2021
Questions_Answers 75P00122R00001.pdf	PDF	Sep 27, 2021
75P00122R00001-Combo Synopsis_Solicitation Amendment 1.pdf	PDF	Sep 27, 2021
J.2_HHS SubContracting Plan Template.pdf	PDF	Sep 21, 2021
75P00122R00001-Combo Synopsis_Solicitation Final.pdf	PDF	Sep 21, 2021

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Base Year

Attachment J.1

RFQ: 75P00122R00001

TITLE: Rapid Medical Examinations for Commissioned Corps Accessions

Base Period
Item #	Description	Frequency	Unit Price	Estimated Quantity	Total
	Transition-In	One-time		1	$0.00

1	Accession Exam (components listed separately)	Per patient	1,500	$0.00
2	HIV Test	Per patient	1,500	$0.00
3	Urine Collection	Per patient	500	$0.00
4	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient	125	$0.00
5	Audiogram	Per patient	500	$0.00
6	Vision (includes color vision)	Per patient	100	$0.00
7	Pregnancy Test	Per patient	500	$0.00
8	Phlebotomy	Per patient	500	$0.00
9	Quantiferon Gold	Per patient	125	$0.00
10	CBC	Per patient	125	$0.00
11	Lipid Panel w/Glucose	Per patient	200	$0.00
12	Hepatitis B Surface Antigen	Per patient	125	$0.00
13	Hepatitis C Titer	Per patient	150	$0.00
14	Retention Exam (components listed separately)	Per patient	17	$0.00
15	Audiogram	Per patient	17	$0.00
16	Vision (includes color vision)	Per patient	17	$0.00
17	Phlebotomy	Per patient	17	$0.00
18	HIV Test	Per patient	17	$0.00

Retention Exam sub-components (as needed)
21	Urine Collection	Per patient	2	$0.00
22	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient	2	$0.00
23	EKG	Per patient	2	$0.00
24	CBC	Per patient	2	$0.00
25	Lipid Panel w/Glucose	Per patient	2	$0.00
26	Thyroid Stimulating Hormone - TSH	Per patient	2	$0.00
27	Chemistry Panel	Per patient	2	$0.00
28	Glycated Hemoglobin A1C	Per patient	2	$0.00
29	Pre-Deployment Health Assessment, DD Form 2795 (Pre-DHA)	Per patient	200	$0.00
30	Post Deployment Health Assessment, DD2796 (PDHA)	Per patient	42	$0.00

Stand-Alone Ancillary Services (ordered as needed)
31	Dental Exam	Per patient		200	$0.00
32	Four Bitewing X-ray	Per patient		84	$0.00
33	Panoramic X-ray	Per patient		84	$0.00
34	Full intraoral bitewing x-ray series	Per patient		2	$0.00
35	One Bitewing X-Ray	Per patient		2	$0.00
36	Two Bitewing X-Ray	Per patient		2	$0.00
37	Three Bitewing X-Ray	Per patient		2	$0.00
38	Hepatitis A	Per patient		2	$0.00
39	Hepatitis B	Per patient		2	$0.00
40		Tetanus/Diphtheria (Td)
Per patient		2	$0.00
41		Influenza (annually)
Per patient		200	$0.00
42	Measles/Mumps/Rubella (MMR)	Per patient		2	$0.00
43	Varicella	Per patient		100	$0.00
44	Tuberculosis Skin Test (PPD)	Per patient		2	$0.00
45	Japanese encephalitis	Per patient		50	$0.00
46	Meningococcal	Per patient		2	$0.00
47	Polio	Per patient		2	$0.00
48	Rabies	Per patient		200	$0.00
49	Tdap	Per patient		2	$0.00
50	Typhoid	Per patient		2	$0.00
51	Twinrix	Per patient		200	$0.00
52	Yellow fever	Per patient		2	$0.00
53	Audio hearing test - pure tone air	Per patient		2	$0.00
54	Vision Screen	Per patient		200	$0.00
55	Color Vision	Per patient		2	$0.00
56	EKG	Per patient		2	$0.00
57	Comprehensive Audiometry - Pure tone air & bone / SPRINT	Per patient		200	$0.00
58	Comprehensive Eye Exam	Per patient		2	$0.00
59	PAP/Pelvic Exam	Per patient		2	$0.00
60	Historical Record Update	Per patient		2	$0.00
61	Urine Collection	Per patient		2	$0.00
62	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient		2	$0.00
63	Drug screen	Per patient		2	$0.00
64	EtOH screen	Per patient		200	$0.00
65	Pregnancy Test	Per patient		2	$0.00
66	Phlebotomy (blood draw)	Per patient		2	$0.00
67	Varicella titer	Per patient		2	$0.00
68	MMR titer	Per patient		200	$0.00
69	HIV test	Per patient		2	$0.00
70	Hepatitis C Antibody	Per patient		2	$0.00
71	Hepatitis B Surface Antigen	Per patient		195	$0.00
72	Thyroid Stimulating Hormone - TSH	Per patient		199	$0.00
73	Urine Culture	Per patient		3	$0.00
74	Serum protein electrophoresis -SPEP	Per patient		10	$0.00
75	Iron Studies	Per patient		2	$0.00
76	Folate	Per patient		2	$0.00
77	B12	Per patient		200	$0.00
78	Quantiferon Gold	Per patient		2	$0.00
79	Chemistry Panel	Per patient		150	$0.00
80	Glycated Hemoglobin A1C	Per patient		2	$0.00
81	Appointment No-show	Per patient		2	$0.00

Estimated CLIN Value $0.00

OY#1

Rapid Medical Exams Price Chart

Option Period 1
Item #	Description	Frequency	Unit Price	Estimated Quantity	Total
1	Accession Exam (components listed separately)	Per patient		1,500	$0.00
2	HIV Test	Per patient		1,500	$0.00
3	Urine Collection	Per patient		500	$0.00
4	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient		125	$0.00
5	Audiogram	Per patient		500	$0.00
6	Vision (includes color vision)	Per patient		100	$0.00
7	Pregnancy Test	Per patient		500	$0.00
8	Phlebotomy	Per patient		500	$0.00
9	Quantiferon Gold	Per patient		125	$0.00
10	CBC	Per patient		125	$0.00
11	Lipid Panel w/Glucose	Per patient		200	$0.00
12	Hepatitis B Surface Antigen	Per patient		125	$0.00
13	Hepatitis C Titer	Per patient		150	$0.00
14	Retention Exam (components listed separately)	Per patient		17	$0.00
15	Audiogram	Per patient		17	$0.00
16	Vision (includes color vision)	Per patient		17	$0.00
17	Phlebotomy	Per patient		17	$0.00
18	HIV Test	Per patient		17	$0.00

Retention Exam sub-components (as needed)
21	Urine Collection	Per patient	2	$0.00
22	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient	2	$0.00
23	EKG	Per patient	2	$0.00
24	CBC	Per patient	2	$0.00
25	Lipid Panel w/Glucose	Per patient	2	$0.00
26	Thyroid Stimulating Hormone - TSH	Per patient	2	$0.00
27	Chemistry Panel	Per patient	2	$0.00
28	Glycated Hemoglobin A1C	Per patient	2	$0.00
29	Pre-Deployment Health Assessment, DD Form 2795 (Pre-DHA)	Per patient	200	$0.00
30	Post Deployment Health Assessment, DD2796 (PDHA)	Per patient	42	$0.00

Stand-Alone Ancillary Services (ordered as needed)
31	Dental Exam	Per patient		200	$0.00
32	Four Bitewing X-ray	Per patient		84	$0.00
33	Panoramic X-ray	Per patient		84	$0.00
34	Full intraoral bitewing x-ray series	Per patient		2	$0.00
35	One Bitewing X-Ray	Per patient		2	$0.00
36	Two Bitewing X-Ray	Per patient		2	$0.00
37	Three Bitewing X-Ray	Per patient		2	$0.00
38	Hepatitis A	Per patient		2	$0.00
39	Hepatitis B	Per patient		2	$0.00
40		Tetanus/Diphtheria (Td)
Per patient		2	$0.00
41		Influenza (annually)
Per patient		200	$0.00
42	Measles/Mumps/Rubella (MMR)	Per patient		2	$0.00
43	Varicella	Per patient		100	$0.00
44	Tuberculosis Skin Test (PPD)	Per patient		2	$0.00
45	Japanese encephalitis	Per patient		50	$0.00
46	Meningococcal	Per patient		2	$0.00
47	Polio	Per patient		2	$0.00
48	Rabies	Per patient		200	$0.00
49	Tdap	Per patient		2	$0.00
50	Typhoid	Per patient		2	$0.00
51	Twinrix	Per patient		200	$0.00
52	Yellow fever	Per patient		2	$0.00
53	Audio hearing test - pure tone air	Per patient		2	$0.00
54	Vision Screen	Per patient		200	$0.00
55	Color Vision	Per patient		2	$0.00
56	EKG	Per patient		2	$0.00
57	Comprehensive Audiometry - Pure tone air & bone / SPRINT	Per patient		200	$0.00
58	Comprehensive Eye Exam	Per patient		2	$0.00
59	PAP/Pelvic Exam	Per patient		2	$0.00
60	Historical Record Update	Per patient		2	$0.00
61	Urine Collection	Per patient		2	$0.00
62	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient		2	$0.00
63	Drug screen	Per patient		2	$0.00
64	EtOH screen	Per patient		200	$0.00
65	Pregnancy Test	Per patient		2	$0.00
66	Phlebotomy (blood draw)	Per patient		2	$0.00
67	Varicella titer	Per patient		2	$0.00
68	MMR titer	Per patient		200	$0.00
69	HIV test	Per patient		2	$0.00
70	Hepatitis C Antibody	Per patient		2	$0.00
71	Hepatitis B Surface Antigen	Per patient		195	$0.00
72	Thyroid Stimulating Hormone - TSH	Per patient		199	$0.00
73	Urine Culture	Per patient		3	$0.00
74	Serum protein electrophoresis -SPEP	Per patient		10	$0.00
75	Iron Studies	Per patient		2	$0.00
76	Folate	Per patient		2	$0.00
77	B12	Per patient		200	$0.00
78	Quantiferon Gold	Per patient		2	$0.00
79	Chemistry Panel	Per patient		150	$0.00
80	Glycated Hemoglobin A1C	Per patient		2	$0.00
81	Appointment No-show	Per patient		2	$0.00

Estimated CLIN Value $0.00

OY#2

Rapid Medical Exams Price Chart

Option Period 2
Item #	Description	Frequency	Unit Price	Estimated Quantity	Total
1	Accession Exam (components listed separately)	Per patient		1,500	$0.00
2	HIV Test	Per patient		1,500	$0.00
3	Urine Collection	Per patient		500	$0.00
4	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient		125	$0.00
5	Audiogram	Per patient		500	$0.00
6	Vision (includes color vision)	Per patient		100	$0.00
7	Pregnancy Test	Per patient		500	$0.00
8	Phlebotomy	Per patient		500	$0.00
9	Quantiferon Gold	Per patient		125	$0.00
10	CBC	Per patient		125	$0.00
11	Lipid Panel w/Glucose	Per patient		200	$0.00
12	Hepatitis B Surface Antigen	Per patient		125	$0.00
13	Hepatitis C Titer	Per patient		150	$0.00
14	Retention Exam (components listed separately)	Per patient		17	$0.00
15	Audiogram	Per patient		17	$0.00
16	Vision (includes color vision)	Per patient		17	$0.00
17	Phlebotomy	Per patient		17	$0.00
18	HIV Test	Per patient		17	$0.00

Retention Exam sub-components (as needed)
21	Urine Collection	Per patient	2	$0.00
22	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient	2	$0.00
23	EKG	Per patient	2	$0.00
24	CBC	Per patient	2	$0.00
25	Lipid Panel w/Glucose	Per patient	2	$0.00
26	Thyroid Stimulating Hormone - TSH	Per patient	2	$0.00
27	Chemistry Panel	Per patient	2	$0.00
28	Glycated Hemoglobin A1C	Per patient	2	$0.00
29	Pre-Deployment Health Assessment, DD Form 2795 (Pre-DHA)	Per patient	200	$0.00
30	Post Deployment Health Assessment, DD2796 (PDHA)	Per patient	42	$0.00

Stand-Alone Ancillary Services (ordered as needed)
31	Dental Exam	Per patient		200	$0.00
32	Four Bitewing X-ray	Per patient		84	$0.00
33	Panoramic X-ray	Per patient		84	$0.00
34	Full intraoral bitewing x-ray series	Per patient		2	$0.00
35	One Bitewing X-Ray	Per patient		2	$0.00
36	Two Bitewing X-Ray	Per patient		2	$0.00
37	Three Bitewing X-Ray	Per patient		2	$0.00
38	Hepatitis A	Per patient		2	$0.00
39	Hepatitis B	Per patient		2	$0.00
40		Tetanus/Diphtheria (Td)
Per patient		2	$0.00
41		Influenza (annually)
Per patient		200	$0.00
42	Measles/Mumps/Rubella (MMR)	Per patient		2	$0.00
43	Varicella	Per patient		100	$0.00
44	Tuberculosis Skin Test (PPD)	Per patient		2	$0.00
45	Japanese encephalitis	Per patient		50	$0.00
46	Meningococcal	Per patient		2	$0.00
47	Polio	Per patient		2	$0.00
48	Rabies	Per patient		200	$0.00
49	Tdap	Per patient		2	$0.00
50	Typhoid	Per patient		2	$0.00
51	Twinrix	Per patient		200	$0.00
52	Yellow fever	Per patient		2	$0.00
53	Audio hearing test - pure tone air	Per patient		2	$0.00
54	Vision Screen	Per patient		200	$0.00
55	Color Vision	Per patient		2	$0.00
56	EKG	Per patient		2	$0.00
57	Comprehensive Audiometry - Pure tone air & bone / SPRINT	Per patient		200	$0.00
58	Comprehensive Eye Exam	Per patient		2	$0.00
59	PAP/Pelvic Exam	Per patient		2	$0.00
60	Historical Record Update	Per patient		2	$0.00
61	Urine Collection	Per patient		2	$0.00
62	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient		2	$0.00
63	Drug screen	Per patient		2	$0.00
64	EtOH screen	Per patient		200	$0.00
65	Pregnancy Test	Per patient		2	$0.00
66	Phlebotomy (blood draw)	Per patient		2	$0.00
67	Varicella titer	Per patient		2	$0.00
68	MMR titer	Per patient		200	$0.00
69	HIV test	Per patient		2	$0.00
70	Hepatitis C Antibody	Per patient		2	$0.00
71	Hepatitis B Surface Antigen	Per patient		195	$0.00
72	Thyroid Stimulating Hormone - TSH	Per patient		199	$0.00
73	Urine Culture	Per patient		3	$0.00
74	Serum protein electrophoresis -SPEP	Per patient		10	$0.00
75	Iron Studies	Per patient		2	$0.00
76	Folate	Per patient		2	$0.00
77	B12	Per patient		200	$0.00
78	Quantiferon Gold	Per patient		2	$0.00
79	Chemistry Panel	Per patient		150	$0.00
80	Glycated Hemoglobin A1C	Per patient		2	$0.00
81	Appointment No-show	Per patient		2	$0.00

Estimated CLIN Value $0.00

OY#3

Rapid Medical Exams Price Chart

Option Period 3
Item #	Description	Frequency	Unit Price	Estimated Quantity	Total
1	Accession Exam (components listed separately)	Per patient		1,500	$0.00
2	HIV Test	Per patient		1,500	$0.00
3	Urine Collection	Per patient		500	$0.00
4	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient		125	$0.00
5	Audiogram	Per patient		500	$0.00
6	Vision (includes color vision)	Per patient		100	$0.00
7	Pregnancy Test	Per patient		500	$0.00
8	Phlebotomy	Per patient		500	$0.00
9	Quantiferon Gold	Per patient		125	$0.00
10	CBC	Per patient		125	$0.00
11	Lipid Panel w/Glucose	Per patient		200	$0.00
12	Hepatitis B Surface Antigen	Per patient		125	$0.00
13	Hepatitis C Titer	Per patient		150	$0.00
14	Retention Exam (components listed separately)	Per patient		17	$0.00
15	Audiogram	Per patient		17	$0.00
16	Vision (includes color vision)	Per patient		17	$0.00
17	Phlebotomy	Per patient		17	$0.00
18	HIV Test	Per patient		17	$0.00

Retention Exam sub-components (as needed)
21	Urine Collection	Per patient	2	$0.00
22	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient	2	$0.00
23	EKG	Per patient	2	$0.00
24	CBC	Per patient	2	$0.00
25	Lipid Panel w/Glucose	Per patient	2	$0.00
26	Thyroid Stimulating Hormone - TSH	Per patient	2	$0.00
27	Chemistry Panel	Per patient	2	$0.00
28	Glycated Hemoglobin A1C	Per patient	2	$0.00
29	Pre-Deployment Health Assessment, DD Form 2795 (Pre-DHA)	Per patient	200	$0.00
30	Post Deployment Health Assessment, DD2796 (PDHA)	Per patient	42	$0.00

Stand-Alone Ancillary Services (ordered as needed)
31	Dental Exam	Per patient		200	$0.00
32	Four Bitewing X-ray	Per patient		84	$0.00
33	Panoramic X-ray	Per patient		84	$0.00
34	Full intraoral bitewing x-ray series	Per patient		2	$0.00
35	One Bitewing X-Ray	Per patient		2	$0.00
36	Two Bitewing X-Ray	Per patient		2	$0.00
37	Three Bitewing X-Ray	Per patient		2	$0.00
38	Hepatitis A	Per patient		2	$0.00
39	Hepatitis B	Per patient		2	$0.00
40		Tetanus/Diphtheria (Td)
Per patient		2	$0.00
41		Influenza (annually)
Per patient		200	$0.00
42	Measles/Mumps/Rubella (MMR)	Per patient		2	$0.00
43	Varicella	Per patient		100	$0.00
44	Tuberculosis Skin Test (PPD)	Per patient		2	$0.00
45	Japanese encephalitis	Per patient		50	$0.00
46	Meningococcal	Per patient		2	$0.00
47	Polio	Per patient		2	$0.00
48	Rabies	Per patient		200	$0.00
49	Tdap	Per patient		2	$0.00
50	Typhoid	Per patient		2	$0.00
51	Twinrix	Per patient		200	$0.00
52	Yellow fever	Per patient		2	$0.00
53	Audio hearing test - pure tone air	Per patient		2	$0.00
54	Vision Screen	Per patient		200	$0.00
55	Color Vision	Per patient		2	$0.00
56	EKG	Per patient		2	$0.00
57	Comprehensive Audiometry - Pure tone air & bone / SPRINT	Per patient		200	$0.00
58	Comprehensive Eye Exam	Per patient		2	$0.00
59	PAP/Pelvic Exam	Per patient		2	$0.00
60	Historical Record Update	Per patient		2	$0.00
61	Urine Collection	Per patient		2	$0.00
62	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient		2	$0.00
63	Drug screen	Per patient		2	$0.00
64	EtOH screen	Per patient		200	$0.00
65	Pregnancy Test	Per patient		2	$0.00
66	Phlebotomy (blood draw)	Per patient		2	$0.00
67	Varicella titer	Per patient		2	$0.00
68	MMR titer	Per patient		200	$0.00
69	HIV test	Per patient		2	$0.00
70	Hepatitis C Antibody	Per patient		2	$0.00
71	Hepatitis B Surface Antigen	Per patient		195	$0.00
72	Thyroid Stimulating Hormone - TSH	Per patient		199	$0.00
73	Urine Culture	Per patient		3	$0.00
74	Serum protein electrophoresis -SPEP	Per patient		10	$0.00
75	Iron Studies	Per patient		2	$0.00
76	Folate	Per patient		2	$0.00
77	B12	Per patient		200	$0.00
78	Quantiferon Gold	Per patient		2	$0.00
79	Chemistry Panel	Per patient		150	$0.00
80	Glycated Hemoglobin A1C	Per patient		2	$0.00
81	Appointment No-show	Per patient		2	$0.00

Estimated CLIN Value $0.00

OY#4

Rapid Medical Exams Price Chart

Option Period 4
Item #	Description	Frequency	Unit Price	Estimated Quantity	Total
1	Accession Exam (components listed separately)	Per patient		1,500	$0.00
2	HIV Test	Per patient		1,500	$0.00
3	Urine Collection	Per patient		500	$0.00
4	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient		125	$0.00
5	Audiogram	Per patient		500	$0.00
6	Vision (includes color vision)	Per patient		100	$0.00
7	Pregnancy Test	Per patient		500	$0.00
8	Phlebotomy	Per patient		500	$0.00
9	Quantiferon Gold	Per patient		125	$0.00
10	CBC	Per patient		125	$0.00
11	Lipid Panel w/Glucose	Per patient		200	$0.00
12	Hepatitis B Surface Antigen	Per patient		125	$0.00
13	Hepatitis C Titer	Per patient		150	$0.00
14	Retention Exam (components listed separately)	Per patient		17	$0.00
15	Audiogram	Per patient		17	$0.00
16	Vision (includes color vision)	Per patient		17	$0.00
17	Phlebotomy	Per patient		17	$0.00
18	HIV Test	Per patient		17	$0.00

Retention Exam sub-components (as needed)
21	Urine Collection	Per patient	2	$0.00
22	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient	2	$0.00
23	EKG	Per patient	2	$0.00
24	CBC	Per patient	2	$0.00
25	Lipid Panel w/Glucose	Per patient	2	$0.00
26	Thyroid Stimulating Hormone - TSH	Per patient	2	$0.00
27	Chemistry Panel	Per patient	2	$0.00
28	Glycated Hemoglobin A1C	Per patient	2	$0.00
29	Pre-Deployment Health Assessment, DD Form 2795 (Pre-DHA)	Per patient	200	$0.00
30	Post Deployment Health Assessment, DD2796 (PDHA)	Per patient	42	$0.00

Stand-Alone Ancillary Services (ordered as needed)
31	Dental Exam	Per patient		200	$0.00
32	Four Bitewing X-ray	Per patient		84	$0.00
33	Panoramic X-ray	Per patient		84	$0.00
34	Full intraoral bitewing x-ray series	Per patient		2	$0.00
35	One Bitewing X-Ray	Per patient		2	$0.00
36	Two Bitewing X-Ray	Per patient		2	$0.00
37	Three Bitewing X-Ray	Per patient		2	$0.00
38	Hepatitis A	Per patient		2	$0.00
39	Hepatitis B	Per patient		2	$0.00
40		Tetanus/Diphtheria (Td)
Per patient		2	$0.00
41		Influenza (annually)
Per patient		200	$0.00
42	Measles/Mumps/Rubella (MMR)	Per patient		2	$0.00
43	Varicella	Per patient		100	$0.00
44	Tuberculosis Skin Test (PPD)	Per patient		2	$0.00
45	Japanese encephalitis	Per patient		50	$0.00
46	Meningococcal	Per patient		2	$0.00
47	Polio	Per patient		2	$0.00
48	Rabies	Per patient		200	$0.00
49	Tdap	Per patient		2	$0.00
50	Typhoid	Per patient		2	$0.00
51	Twinrix	Per patient		200	$0.00
52	Yellow fever	Per patient		2	$0.00
53	Audio hearing test - pure tone air	Per patient		2	$0.00
54	Vision Screen	Per patient		200	$0.00
55	Color Vision	Per patient		2	$0.00
56	EKG	Per patient		2	$0.00
57	Comprehensive Audiometry - Pure tone air & bone / SPRINT	Per patient		200	$0.00
58	Comprehensive Eye Exam	Per patient		2	$0.00
59	PAP/Pelvic Exam	Per patient		2	$0.00
60	Historical Record Update	Per patient		2	$0.00
61	Urine Collection	Per patient		2	$0.00
62	Urinalysis, complete w/ reflex microscope (p.r.n.)	Per patient		2	$0.00
63	Drug screen	Per patient		2	$0.00
64	EtOH screen	Per patient		200	$0.00
65	Pregnancy Test	Per patient		2	$0.00
66	Phlebotomy (blood draw)	Per patient		2	$0.00
67	Varicella titer	Per patient		2	$0.00
68	MMR titer	Per patient		200	$0.00
69	HIV test	Per patient		2	$0.00
70	Hepatitis C Antibody	Per patient		2	$0.00
71	Hepatitis B Surface Antigen	Per patient		195	$0.00
72	Thyroid Stimulating Hormone - TSH	Per patient		199	$0.00
73	Urine Culture	Per patient		3	$0.00
74	Serum protein electrophoresis -SPEP	Per patient		10	$0.00
75	Iron Studies	Per patient		2	$0.00
76	Folate	Per patient		2	$0.00
77	B12	Per patient		200	$0.00
78	Quantiferon Gold	Per patient		2	$0.00
79	Chemistry Panel	Per patient		150	$0.00
80	Glycated Hemoglobin A1C	Per patient		2	$0.00
81	Appointment No-show	Per patient		2	$0.00

Estimated CLIN Value $0.00

File details come from the government source that posted it. Updated Sep 21, 2021.