99SWC-S2474 Cost Schedule.docx
DOCX document 59 KB Posted
- Attached to
- Occupational Health Services
- Solicitation number
- 99SWC-S2474
- Issued by
- Churchill County, Nevada
About this file
This document is a cost schedule for occupational health services provided to the State of Nevada. It outlines the components and pricing for various physical examination panels, as well as optional components, hazardous material (HAZMAT) related physicals, and termination testing requirements. The services are intended to meet the needs of multiple state agencies, including the Department of Corrections, Southern Nevada Adult Mental Health Services, and Lakes Crossing.
The cost schedule provides detailed pricing for a range of medical services, including audiometry, blood pressure monitoring, chest x-rays, coronary risk assessments, physical exams, EKGs, pulmonary function tests, vision screenings, and various inoculations and vaccinations. Pricing is provided for both standard and rural/mobile service delivery. The document also includes pricing for optional services, such as cardiology consultations, CT scans, and physical therapy assessments.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 99SWC-S2474 Q and A Answered..xls | XLS spreadsheet | |
| 99SWC-S2474 Technical Requirements Questionnaire.docx | DOCX document | |
| Attachments for Signatures 2023-04-13~1.pdf | ||
| Heart and Lung Physical Examination Form.docx | DOCX document | |
| Physical Exams Form.docx | DOCX document | |
| Quote Instructions.pdf | ||
| Reference Questionnaire 2023-04-13~1.docx | DOCX document | |
| Standard Form Contract~5.docx | DOCX document | |
| 99SWC-S2474 Insurance Schedule.docx | DOCX document | |
| Firemen and Police Medical History Form.doc | DOC document | |
| Risk Factor Levels for Various Conditions.docx | DOCX document | |
| Terms and Conditions for Services 2023-04-13~1.pdf | ||
| 99SWC-S2474 Letter of Intent.pdf | ||
| 99SWC-S2474 RFQ Occupational Health Services~1.docx | DOCX document | |
| Projected Physicals for Years 2024-2028.docx | DOCX document | |
| Proposed Staff Resume 2023-04-13~1.docx | DOCX document |
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Text version
COST SCHEDULE
Components of Physical Panel 1
Cost
State of Nevada Medical History Form
Audiometry w/interpretation (identify air conduction or pure tone test)
Blood Pressure Monitoring
Chest X-Ray (1 view) radiologist over-read
Coronary Risk II (CBC + Chem Panel + HDL + LDL
Heart Lung Physical Exam
Resting EKG
Pulmonary Function Test (Spirometry)
Vision Screening
TB Skin test -2 Step TB skin NDOC, SNAMHS, Lakes Crossing.
TB Skin test – 1 Step TB skin - All other Agencies.
Urinalysis
Nicotine Test (Cotinine Only) with Quant Levels
Per Cent Body Fat (BMI Method) /Waist Circumference
* A1c - If employee has documented Diabetes
State of Nevada Physician's Report of Results Form
Written Report to Agency and Employee
Hepatitis ABC Antibody Screening
Hepatitis A/B Inoculation Series, must be offered if the employee has not been previously inoculated -Vendor must provide a card identifying status and dates of inoculations
Hepatitis A Vaccine (2 shot series) price per injection
Hepatitis B Vaccine (3 shot series) price per injection
Heplisav B (2 shot series) price per injection
Total Cost of Physical
Rural Fees
Rural fee
Mobile Fee
Total Cost of Rural Physical
Vendor Name _____________________________________ Occupational Health Services
COST SCHEDULE
Components of Physical Panel 2
Cost
Audiometry w/interpretation (identify air conduction or pure tone test)
Resting EKG
Pulmonary Function Test (Spirometry)
Vision Screening
Total Cost of Physical
Rural Fees
Rural Fee
Mobile Fee
Total Cost of Rural Physical
Components of Physical Panel 3
Cost
State of Nevada Medical History Form
Audiometry w/interpretation (identify air conduction or pure tone test)
Blood Pressure Monitoring
Chest X-Ray (2 View) radiologist over-read
Coronary Risk II (CBC + Chem Panel + HDL + LDL
Heart Lung Physical Exam
Stress EKG
Pulmonary Function Test (Spirometry)
Vision Screening
TB Skin Test - Exception: Dept. of Corrections and Lakes Crossing employees do not receive TB test
Urinalysis
Nicotine Test (Cotinine Only) with Quant Levels
Per Cent Body Fat (BMI Method) /Waist Circumference
* A1c - If employee has documented Diabetes
State of Nevada Physician's Report of Results Form
Written Report to Agency and Employee
Hepatitis ABC Antibody Screening
Hepatitis A/B Inoculation Series, must be offered if the employee has not been previously inoculated -Vendor must provide a card identifying status and dates of inoculations
Hepatitis A Vaccine (2 shot series) price per injection
Hepatitis B Vaccine (3 shot series) price per injection
Heplisav – B (2 shot series) price per injection
Total Cost of Physical
Rural Fees
Rural Fee
Mobile Fee
Total Cost of Rural Physical
Components of Physical Panel 4
Cost
Audiometry w/interpretation (identify air conduction or pure tone test)
Blood Pressure Monitoring
Chest X-Ray (1 view) radiologist over-read
Resting EKG
Pulmonary Function Test (Spirometry)
Vision Screening
Total Cost of Physical
Rural Fees
Rural Fee
Mobile Fee
Total Cost of Rural Physical
Components of Physical Panel 5
Cost
State of Nevada Medical History Form
Audiometry w/interpretation (identify air conduction or pure tone test)
Blood Pressure Monitoring
Chest X-Ray (1 view) radiologist over-read
Coronary Risk II (CBC + Chem Panel + HDL + LDL
Heart Lung Physical Exam
Resting EKG
Pulmonary Function Test (Spirometry)
Vision Screening
TB Skin Test
Urinalysis
Nicotine Test (Cotinine Only) with Quant Levels
Per Cent Body Fat (BMI Method) /Waist Circumference
A1c - If employee has documented Diabetes
State of Nevada Physician's Report of Results Form
Written Report to Agency and Employee
Hepatitis ABC Antibody Screening
Hepatitis A/B Inoculation Series (First year only, if indicated
Total Cost of Physical
Rural Fees
Rural Fee
Mobile fee
Total Cost of Rural Physical
COST SCHEDULE
Optional Components of a Physical Exam
Cost
Hepatitis Testing
Hepatitis Profile Screening
Hepatitis A
Hepatitis B surface Ag
Hepatitis B surface Ab
Hepatitis B core Ab
Hepatitis C Ab
HIV Testing
HIV 1 & 2 Screen (AIDS Screening)
HIV I & II - Western Blot
HIV 11 Screen
Immunoblot Confirmation
Confirmation Charges on Hepatitis (if Positive)
Hep A -Hep A IgM
Hep B Ag - Neutralization Assay
Hep C - HCV RIBA
Hepatitis Inoculations
Hepatitis A inoculations
Heplisav -B
TwinRix (Hep A and B) inoculations
Respirator Clearance Exams
Respiratory Fit Test
OSHA Respirator Questionnaire
Pulmonary Function Test
Respirator Clearance Letter
Department of Transportation/CDL Exams
DOT Examinations
DOT Paperwork
Optional Components of a Physical Exam (Cont’d)
Cost
Drug and Alcohol Testing
DOT Urine Drug Screen
Non-DOT Urine Drug Screen
DOT Breath Alcohol Test
Non-DOT Breath Alcohol Test
Breath Alcohol Confirmation (if positive)
Individual Test Pricing (Not part of Heart and Lung Physical)
Audiometry with interpretation (air conduction or pure tone test)
Chest X-Ray (Single View)
Chest X-Ray (Dual View) includes radiologist over-read
Coronary Risk II (CBC + Chem. Panel + HDL + LDL)
Resting EKG
Stress EKG (Graded Exercise Test)
TB Skin Test
Nicotine Test (Cotinine Only) with Quant Levels
Per-Cent Body Fat (BMI Method)/Waist Circumference
Pulmonary Function Test
Normal Vision screening (Snellen, Far, Near)
Advanced Vision Screening (Ishihara, Depth, Peripheral)
Venipuncture
Psychological Screening and Interpretation
Psychological Evaluation/Consultation/Interview -Pre-hire
Psychological Evaluation 1
Psychological Evaluation 2
Fitness for Duty – Non-occupational condition or potential workplace violence situation psychological interview, testing and evaluation
Fitness for Duty – medical evaluation
Annual Wellness Evaluation
Annual wellness visit for peace officers to aid in preserving the emotional and mental health of the officer.
Cardiology
Office visit- consultation
Follow-up office visit
24 Hour Holter Monitor Tech and Professional
24 Hour Holter Monitor interpretation
ECG Monitor 24 hr w/Scan & Recording
COST SCHEDULE
Optional Components of a Physical Exam (Cont’d)
Cost
Cardiology cont.
Cardiolite Stress test
Lexiscan Stress test
Echocardiogram
Echocardiogram with TAPSE
Pulmonology
Consultation
Follow-up visit
PFT
Spirometry
Audiologist
Consultation - Southern Nevada
Consultation – Northern Nevada
CT Scan
CT Calcium Scoring
CT Chest with Contrast
CT Chest w/o Contrast
Coronary CTA
Echo w/Rest & CV Stress
Physical Assessment screening (Physical Therapy)
Return to work examination
Functional Capacity Evaluation (per hour)
Musculoskeletal Evaluation
Physical Capacity Evaluation
Rural Fees
Rural Fee
Mobile Fee
Misc Vaccinations/tests
Rabies Titer
QuantiFERON TB test
Polio vaccination
Tetanus
COST SCHEDULE
Termination Testing Components
Cost
Testing within 30 days of termination
TB Skin Test
Hepatitis Profile Screening
HIV 1 & 2 Screen
Total 30 Day Termination Testing
Testing 90 Days of Termination
TB Skin Test
Total 90 Day Termination Test
Testing 180 Days of Termination
Hepatitis Profile Screening
HIV 1 & 2 Screen
Total 180 Days of Termination Testing
Testing at 365 Days of Termination
Hepatitis Profile Screening
HIV 1 & 2 Screen
Total 365 Days Termination Testing
Components of Hazmat I Baseline Physical
Cost
Audiogram
Blood Lead ZPP
Chem Panel + CBC + UA
Chest X-Ray 3 view
Cholinesterase RBC (Serum)
Heavy Metals/24 Hr Urine
Hep A - 2 shot inoculation series
Hep B -3 shot inoculation series
Hep C Reba test (if positive C from screen)
Hepatitis Panel Screen (A,B,C)
PCB Serum
Physical Exam
Physician's Statement
Pulmonary Function Test (Spirometry)
Respiratory Compliance Letter
Review of Medical Questionnaire/HazMat Form
Stress EKG
Tetanus inoculation (Tdap)
Total Cost of Physical Exam
Components of Hazmat Level I Annual Physical
Cost
Audiogram
Benzene (Exposure to gasoline)
Blood Lead ZPP
Chem Panel + CBC + UA
Chest X-Ray 3 view
Cholinesterase RBC (Serum)
Heavy Metals/24 Hr Urine
Hepatitis B Antibody
PCB Serum
Physical Exam
Physician's Statement
Pulmonary Function Test (Spirometry)
Respiratory Compliance Letter
Review of Medical Questionnaire/HazMat Form
Stress EKG test
Total Cost of Physical
Components of Hazmat Level I Termination Physical
Cost
Audiogram
Blood Lead ZPP
Chem Panel + CBC + UA
Chest X-Ray 3 view
Cholinesterase RBC (Serum)
Heavy Metals/24 Hr Urine
Hep C Reba test (if positive C from screen)
Hepatitis Panel Complete A, B, C
PCB Serum
Physical Exam
Physician's Statement
Pulmonary Function Test (Spirometry)
Respiratory Compliance Letter
Review of Medical Questionnaire/HazMat Form
Stress EKG test
Total Cost of Physical
Components of Hazmat Level II Baseline Physical
Cost
Audiogram
Blood Lead ZPP
Chem Panel + CBC + UA
Chest X-ray 2 view
Cholinesterase RBC (Serum)
EKG (Resting)
Heavy Metals/24 Hr Urine
Hep A - 2 shot inoculation series
Hep B -3 shot inoculation series
Hep C Reba test (if positive C from screen)
Hepatitis Panel Complete A, B, C
PCB Serum
Physical Exam
Physician's Statement
Pulmonary Function Test (Spirometry)
Review of Medical Questionnaire/HazMat Form
Tetanus inoculation (Tdap)
Total Cost of Physical
Components of Hazmat Level II Annual Physical
Cost
Audiogram
Benzene (Exposure to gasoline)
Blood Lead ZPP
Chem Panel + CBC + UA
Chest X-ray 2 view
Cholinesterase RBC (Serum)
EKG (Resting)
Heavy Metals/24 Hr Urine
Hepatitis B Antibody
PCB Serum
Physical Exam
Physician's Statement
Pulmonary Function Test (Spirometry)
Review of Medical Questionnaire/HazMat Form
Total Cost of Physical
Components of Hazmat Level II Termination Physical
Cost
Audiogram
Blood Lead ZPP
Chem Panel + CBC + UA
Chest X-Ray 2 view
Cholinesterase RBC (Serum)
EKG (Resting)
Heavy Metals/24 Hr Urine
Hep C Reba test (if positive C from screen)
Hepatitis Panel Complete A, B, C
PCB Serum
Physical Exam
Physician's Statement
Pulmonary Function Test (Spirometry)
Review of Medical Questionnaire/HazMat Form
Total Cost of Physical
Components of Hazmat Level III Baseline Physical
Cost
Audiogram
Chem Panel + CBC + UA
Chest X-ray 2 view
Hep A - 2 shot inoculation series
Hep B -3 shot inoculation series
Hep C Reba test (if positive C from screen)
Hepatitis Panel Complete A, B, C
Physical Exam
Physician's Statement
Review of Medical Questionnaire/HazMat Form
Tetanus inoculation (Tdap)
Total Cost of Physical
Components of Hazmat Level III -Biennial Physical
Cost
Audiogram
Benzene (Exposure to gasoline)
Chem Panel + CBC + UA
Hepatitis B Antibody
Physical Exam
Physician's Statement
Review of Medical Questionnaire/HazMat Form
Total Cost of Physical
Page | 2 RFQ 99SWC-2474
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