A19-J.1.a - Supplemental Pricing Schedule.xlsx

XLSX spreadsheet 63 KB Posted Sep 15, 2025

Attached to: Directed Medical Services for the Department of Labor, Office of Workers' Compensation Programs (OWCP), Division of Federal Employees Compensation (DFEC) program
Solicitation number: 1605C3-25-R-00007
Issued by: Department of Labor Office of the Assistant Secretary for Administration and Management

About this file

Written by GovTribe AI · Sep 15, 2025

This is a Supplemental Pricing Schedule for RFP 1605C3-25-R-00007, detailing pricing and estimated quantities for Directed Medical Services for the Department of Labor's Division of Federal Employees Compensation (DFEC) program. The document presents a comprehensive breakdown of medical service estimates across multiple medical specialties (Internal Medicine, Orthopedic Surgery, Pulmonary Medicine, Otolaryngology, Neurology, Psychiatry, and Other Specialists) for all 50 U.S. states, U.S. Possessions, Territories, and Trust Territories.

The pricing schedule includes four option periods with consistent estimated quantities across different states, and defines specific pricing for various Contract Line Item Numbers (CLINs). These CLINs cover supplemental reports ($1,700), surgical file reviews (ranging from $330 for different page ranges), impairment rating file reviews ($200), other file reviews ($200), travel/transportation (pay-as-billed), and other direct costs. Notably, the document includes specific provisions for billing scenarios such as claimant no-shows ($200 fixed rate), interpreter services (pay-as-billed), diagnostic tests (billed per OWCP Fee Schedule), and other ancillary services, providing a detailed pricing framework for medical services supporting federal employee compensation claims.

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File	Type	Posted
1605C3-25-R-00007.pdf	PDF	Sep 15, 2025
A19-J.3 - QUESTION AND ANSWER SPREADSHEET.xlsx	XLSX spreadsheet	Sep 15, 2025
A19-J.2 – SMALL BUSINESS SUBCONTRACTING PLAN TEMPLATE.docx	DOCX document	Sep 15, 2025
A19-J.1 - Pricing Schedule.xlsx	XLSX spreadsheet	Sep 15, 2025
A19-J.2 – SMALL BUSINESS SUBCONTRACTING PLAN TEMPLATE.xlsx	XLSX spreadsheet	Sep 15, 2025
A19-J.4 – PAST PERFORMANCE QUESTIONNAIRE.docx	DOCX document	Sep 15, 2025

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Base Period

RFP 1605C3-25-R-00007 - Directed Medical Services for the Division of Federal Employees Compensation
State/Location	Internal Medicine	Estimated Quantity	Projected Value	Orthopedic surgery	Estimated Quantity	Projected Value	Pulmonary Medicine	Estimated Quantity	Projected Value	Otolaryngology	Estimated Quantity	Projected Value	Neurology	Estimated Quantity	Projected Value	Psychiatry	Estimated Quantity	Projected Value	Othter Specialists	Estimated Quantity	Projected Value
Possessions	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
Territories	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
Trust Territories	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
AK	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
AL	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	34	$0.00	$0.00	16	$0.00	$0.00	27	$0.00	$0.00	4	$0.00
AR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	21	$0.00	$0.00	10	$0.00	$0.00	16	$0.00	$0.00	3	$0.00
AZ	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	32	$0.00	$0.00	14	$0.00	$0.00	25	$0.00	$0.00	4	$0.00
CA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	21	$0.00	$0.00	186	$0.00	$0.00	83	$0.00	$0.00	145	$0.00	$0.00	21	$0.00
CT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	8	$0.00	$0.00	2	$0.00
CO	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	22	$0.00	$0.00	10	$0.00	$0.00	17	$0.00	$0.00	3	$0.00
DC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
DE	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	4	$0.00	$0.00	6	$0.00	$0.00	1	$0.00
FL North	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	13	$0.00	$0.00	110	$0.00	$0.00	49	$0.00	$0.00	85	$0.00	$0.00	13	$0.00
FL Central	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
FL South	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
GA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	73	$0.00	$0.00	33	$0.00	$0.00	57	$0.00	$0.00	9	$0.00
HI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	17	$0.00	$0.00	8	$0.00	$0.00	14	$0.00	$0.00	2	$0.00
IA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
ID	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
IL	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	10	$0.00	$0.00	86	$0.00	$0.00	39	$0.00	$0.00	67	$0.00	$0.00	10	$0.00
IN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	13	$0.00	$0.00	6	$0.00	$0.00	10	$0.00	$0.00	2	$0.00
KS	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
KY	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	23	$0.00	$0.00	11	$0.00	$0.00	18	$0.00	$0.00	3	$0.00
LA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	42	$0.00	$0.00	19	$0.00	$0.00	33	$0.00	$0.00	5	$0.00
MA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	35	$0.00	$0.00	16	$0.00	$0.00	27	$0.00	$0.00	4	$0.00
MD	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	72	$0.00	$0.00	32	$0.00	$0.00	56	$0.00	$0.00	8	$0.00
ME	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	4	$0.00	$0.00	6	$0.00	$0.00	1	$0.00
MI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	30	$0.00	$0.00	14	$0.00	$0.00	24	$0.00	$0.00	4	$0.00
MN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	8	$0.00	$0.00	2	$0.00
MO	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	22	$0.00	$0.00	10	$0.00	$0.00	18	$0.00	$0.00	3	$0.00
MS	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	4	$0.00	$0.00	7	$0.00	$0.00	1	$0.00
MT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
NC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	7	$0.00	$0.00	57	$0.00	$0.00	25	$0.00	$0.00	44	$0.00	$0.00	7	$0.00
ND	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
NE	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
NH	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
NJ	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	33	$0.00	$0.00	15	$0.00	$0.00	26	$0.00	$0.00	4	$0.00
NM	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
NV	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	15	$0.00	$0.00	7	$0.00	$0.00	12	$0.00	$0.00	2	$0.00
NY (Upstate)	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	12	$0.00	$0.00	105	$0.00	$0.00	47	$0.00	$0.00	82	$0.00	$0.00	12	$0.00
NY (Downstate)	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
OH	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	51	$0.00	$0.00	23	$0.00	$0.00	40	$0.00	$0.00	6	$0.00
OK	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	51	$0.00	$0.00	23	$0.00	$0.00	40	$0.00	$0.00	6	$0.00
OR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	14	$0.00	$0.00	7	$0.00	$0.00	11	$0.00	$0.00	2	$0.00
PA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	49	$0.00	$0.00	22	$0.00	$0.00	38	$0.00	$0.00	6	$0.00
PR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
RI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	4	$0.00	$0.00	7	$0.00	$0.00	1	$0.00
SC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	25	$0.00	$0.00	11	$0.00	$0.00	20	$0.00	$0.00	3	$0.00
SD	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
TN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	25	$0.00	$0.00	11	$0.00	$0.00	19	$0.00	$0.00	3	$0.00
TX	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	32	$0.00	$0.00	284	$0.00	$0.00	126	$0.00	$0.00	221	$0.00	$0.00	32	$0.00
UT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	9	$0.00	$0.00	2	$0.00
VA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	38	$0.00	$0.00	17	$0.00	$0.00	29	$0.00	$0.00	5	$0.00
VT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
WA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	42	$0.00	$0.00	19	$0.00	$0.00	33	$0.00	$0.00	5	$0.00
WI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	12	$0.00	$0.00	6	$0.00	$0.00	10	$0.00	$0.00	2	$0.00
WV	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	3	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
WY	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00

CLIN 0004 Supplemental Reports
CLIN 0004 Supplemental Reports	$	1700

CLIN 0005 File Review Surgical
CLIN 0005 File Review Surgical (1-100 Pages)	$	330
CLIN 0005 File Review Surical (101-250 Pages)	$	330
CLIN 0005 File Review Surgical (250+ Pages)	$	330

CLIN 0006 File Review--Impariment Rating
CLIN 0006 File Review-Impariment Rating (1-100 Pages)	$	200
CLIN 0006 File Review-Impairment Rating (101-250 Pages)	$	200
CLIN 0006 File Review- Impairment Rating (250+ Pages)	$	200

CLIN 0007 File Review Other
CLIN 0007 File Review Other (1-100 Pages)	$	200
CLIN 0007 File Review Other (101-250 Pages)	$	200
CLIN 0007 File Review Other (250+ Pages)	$	200

CLIN 0008 Travel/Transportation
CLIN 0008 Travel/Transportation	Pay-As-Billed Per OWCP CPT Code

CLIN 0009 Other Direct Cost - Canceled Appointments, Interpretive Services, Diagnostic Tests, and all other ancillary services

CLIN 0009 Claimant No-Show/Government Cancelations less than 24 hour notice	Billed/Paid at the fixed rate of $200 Per OWCP CPT Code
CLIN 0009 Interpreter Services	Pay-As-Billed Per OWCP CPT Code
CLIN 0009 Diagnostic Tests	Billed/Paid Per OWCP Fee Schedule
CLIN 0009 All other ancillary services	Billed/Paid Per OWCP Fee Schedule

Option Period 1

RFP 1605C3-25-R-00007 - Directed Medical Services for the Division of Federal Employees Compensation
State/Location	Internal Medicine	Estimated Quantity	Projected Value	Orthopedic surgery	Estimated Quantity	Projected Value	Pulmonary Medicine	Estimated Quantity	Projected Value	Otolaryngology	Estimated Quantity	Projected Value	Neurology	Estimated Quantity	Projected Value	Psychiatry	Estimated Quantity	Projected Value	Othter Specialists	Estimated Quantity	Projected Value
Possessions	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
Territories	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
Trust Territories	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
AK	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
AL	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	34	$0.00	$0.00	16	$0.00	$0.00	27	$0.00	$0.00	4	$0.00
AR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	21	$0.00	$0.00	10	$0.00	$0.00	16	$0.00	$0.00	3	$0.00
AZ	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	32	$0.00	$0.00	14	$0.00	$0.00	25	$0.00	$0.00	4	$0.00
CA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	21	$0.00	$0.00	186	$0.00	$0.00	83	$0.00	$0.00	145	$0.00	$0.00	21	$0.00
CT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	8	$0.00	$0.00	2	$0.00
CO	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	22	$0.00	$0.00	10	$0.00	$0.00	17	$0.00	$0.00	3	$0.00
DC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
DE	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	4	$0.00	$0.00	6	$0.00	$0.00	1	$0.00
FL North	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	13	$0.00	$0.00	110	$0.00	$0.00	49	$0.00	$0.00	85	$0.00	$0.00	13	$0.00
FL Central	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
FL South	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
GA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	73	$0.00	$0.00	33	$0.00	$0.00	57	$0.00	$0.00	9	$0.00
HI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	17	$0.00	$0.00	8	$0.00	$0.00	14	$0.00	$0.00	2	$0.00
IA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
ID	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
IL	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	10	$0.00	$0.00	86	$0.00	$0.00	39	$0.00	$0.00	67	$0.00	$0.00	10	$0.00
IN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	13	$0.00	$0.00	6	$0.00	$0.00	10	$0.00	$0.00	2	$0.00
KS	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
KY	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	23	$0.00	$0.00	11	$0.00	$0.00	18	$0.00	$0.00	3	$0.00
LA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	42	$0.00	$0.00	19	$0.00	$0.00	33	$0.00	$0.00	5	$0.00
MA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	35	$0.00	$0.00	16	$0.00	$0.00	27	$0.00	$0.00	4	$0.00
MD	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	72	$0.00	$0.00	32	$0.00	$0.00	56	$0.00	$0.00	8	$0.00
ME	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	4	$0.00	$0.00	6	$0.00	$0.00	1	$0.00
MI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	30	$0.00	$0.00	14	$0.00	$0.00	24	$0.00	$0.00	4	$0.00
MN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	8	$0.00	$0.00	2	$0.00
MO	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	22	$0.00	$0.00	10	$0.00	$0.00	18	$0.00	$0.00	3	$0.00
MS	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	4	$0.00	$0.00	7	$0.00	$0.00	1	$0.00
MT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
NC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	7	$0.00	$0.00	57	$0.00	$0.00	25	$0.00	$0.00	44	$0.00	$0.00	7	$0.00
ND	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
NE	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
NH	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
NJ	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	33	$0.00	$0.00	15	$0.00	$0.00	26	$0.00	$0.00	4	$0.00
NM	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
NV	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	15	$0.00	$0.00	7	$0.00	$0.00	12	$0.00	$0.00	2	$0.00
NY (Upstate)	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	12	$0.00	$0.00	105	$0.00	$0.00	47	$0.00	$0.00	82	$0.00	$0.00	12	$0.00
NY (Downstate)	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
OH	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	51	$0.00	$0.00	23	$0.00	$0.00	40	$0.00	$0.00	6	$0.00
OK	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	51	$0.00	$0.00	23	$0.00	$0.00	40	$0.00	$0.00	6	$0.00
OR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	14	$0.00	$0.00	7	$0.00	$0.00	11	$0.00	$0.00	2	$0.00
PA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	49	$0.00	$0.00	22	$0.00	$0.00	38	$0.00	$0.00	6	$0.00
PR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
RI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	4	$0.00	$0.00	7	$0.00	$0.00	1	$0.00
SC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	25	$0.00	$0.00	11	$0.00	$0.00	20	$0.00	$0.00	3	$0.00
SD	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
TN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	25	$0.00	$0.00	11	$0.00	$0.00	19	$0.00	$0.00	3	$0.00
TX	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	32	$0.00	$0.00	284	$0.00	$0.00	126	$0.00	$0.00	221	$0.00	$0.00	32	$0.00
UT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	9	$0.00	$0.00	2	$0.00
VA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	38	$0.00	$0.00	17	$0.00	$0.00	29	$0.00	$0.00	5	$0.00
VT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
WA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	42	$0.00	$0.00	19	$0.00	$0.00	33	$0.00	$0.00	5	$0.00
WI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	12	$0.00	$0.00	6	$0.00	$0.00	10	$0.00	$0.00	2	$0.00
WV	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	3	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
WY	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00

CLIN 1004 Supplemental Reports
CLIN 1004 Supplemental Reports	$	1700

CLIN 1005 File Review Surgical
CLIN 1005 File Review Surgical (1-100 Pages)	$	330
CLIN 1005 File Review Surical (101-250 Pages)	$	330
CLIN 1005 File Review Surgical (250+ Pages)	$	330

CLIN 1006 File Review--Impariment Rating
CLIN 1006 File Review-Impariment Rating (1-100 Pages)	$	200
CLIN 1006 File Review-Impairment Rating (101-250 Pages)	$	200
CLIN 1006 File Review- Impairment Rating (250+ Pages)	$	200

CLIN 1007 File Review Other
CLIN 1007 File Review Other (1-100 Pages)	$	200
CLIN 1007 File Review Other (101-250 Pages)	$	200
CLIN 1007 File Review Other (250+ Pages)	$	200

CLIN 1008 Travel/Transportation
CLIN 1008 Travel/Transportation	Pay-As-Billed Per OWCP CPT Code

CLIN 1009 Other Direct Cost - Canceled Appointments, Interpretive Services, Diagnostic Tests, and all other ancillary services

CLIN 1009 Claimant No-Show/Government Cancelations less than 24 hour notice	Billed/Paid at the fixed rate of $200 Per OWCP CPT Code
CLIN 1009 Interpreter Services	Pay-As-Billed Per OWCP CPT Code
CLIN 1009 Diagnostic Tests	Billed/Paid Per OWCP Fee Schedule
CLIN 1009 All other ancillary services	Billed/Paid Per OWCP Fee Schedule

Option Period 2

RFP 1605C3-25-R-00007 - Directed Medical Services for the Division of Federal Employees Compensation
State/Location	Internal Medicine	Estimated Quantity	Projected Value	Orthopedic surgery	Estimated Quantity	Projected Value	Pulmonary Medicine	Estimated Quantity	Projected Value	Otolaryngology	Estimated Quantity	Projected Value	Neurology	Estimated Quantity	Projected Value	Psychiatry	Estimated Quantity	Projected Value	Othter Specialists	Estimated Quantity	Projected Value
Possessions	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
Territories	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
Trust Territories	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
AK	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
AL	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	34	$0.00	$0.00	16	$0.00	$0.00	27	$0.00	$0.00	4	$0.00
AR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	21	$0.00	$0.00	10	$0.00	$0.00	16	$0.00	$0.00	3	$0.00
AZ	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	32	$0.00	$0.00	14	$0.00	$0.00	25	$0.00	$0.00	4	$0.00
CA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	21	$0.00	$0.00	186	$0.00	$0.00	83	$0.00	$0.00	145	$0.00	$0.00	21	$0.00
CT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	8	$0.00	$0.00	2	$0.00
CO	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	22	$0.00	$0.00	10	$0.00	$0.00	17	$0.00	$0.00	3	$0.00
DC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
DE	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	4	$0.00	$0.00	6	$0.00	$0.00	1	$0.00
FL North	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	13	$0.00	$0.00	110	$0.00	$0.00	49	$0.00	$0.00	85	$0.00	$0.00	13	$0.00
FL Central	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
FL South	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
GA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	73	$0.00	$0.00	33	$0.00	$0.00	57	$0.00	$0.00	9	$0.00
HI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	17	$0.00	$0.00	8	$0.00	$0.00	14	$0.00	$0.00	2	$0.00
IA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
ID	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
IL	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	10	$0.00	$0.00	86	$0.00	$0.00	39	$0.00	$0.00	67	$0.00	$0.00	10	$0.00
IN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	13	$0.00	$0.00	6	$0.00	$0.00	10	$0.00	$0.00	2	$0.00
KS	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
KY	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	23	$0.00	$0.00	11	$0.00	$0.00	18	$0.00	$0.00	3	$0.00
LA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	42	$0.00	$0.00	19	$0.00	$0.00	33	$0.00	$0.00	5	$0.00
MA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	35	$0.00	$0.00	16	$0.00	$0.00	27	$0.00	$0.00	4	$0.00
MD	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	72	$0.00	$0.00	32	$0.00	$0.00	56	$0.00	$0.00	8	$0.00
ME	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	4	$0.00	$0.00	6	$0.00	$0.00	1	$0.00
MI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	30	$0.00	$0.00	14	$0.00	$0.00	24	$0.00	$0.00	4	$0.00
MN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	8	$0.00	$0.00	2	$0.00
MO	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	22	$0.00	$0.00	10	$0.00	$0.00	18	$0.00	$0.00	3	$0.00
MS	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	4	$0.00	$0.00	7	$0.00	$0.00	1	$0.00
MT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
NC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	7	$0.00	$0.00	57	$0.00	$0.00	25	$0.00	$0.00	44	$0.00	$0.00	7	$0.00
ND	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
NE	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
NH	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
NJ	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	33	$0.00	$0.00	15	$0.00	$0.00	26	$0.00	$0.00	4	$0.00
NM	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
NV	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	15	$0.00	$0.00	7	$0.00	$0.00	12	$0.00	$0.00	2	$0.00
NY (Upstate)	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	12	$0.00	$0.00	105	$0.00	$0.00	47	$0.00	$0.00	82	$0.00	$0.00	12	$0.00
NY (Downstate)	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
OH	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	51	$0.00	$0.00	23	$0.00	$0.00	40	$0.00	$0.00	6	$0.00
OK	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	51	$0.00	$0.00	23	$0.00	$0.00	40	$0.00	$0.00	6	$0.00
OR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	14	$0.00	$0.00	7	$0.00	$0.00	11	$0.00	$0.00	2	$0.00
PA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	49	$0.00	$0.00	22	$0.00	$0.00	38	$0.00	$0.00	6	$0.00
PR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
RI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	4	$0.00	$0.00	7	$0.00	$0.00	1	$0.00
SC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	25	$0.00	$0.00	11	$0.00	$0.00	20	$0.00	$0.00	3	$0.00
SD	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
TN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	25	$0.00	$0.00	11	$0.00	$0.00	19	$0.00	$0.00	3	$0.00
TX	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	32	$0.00	$0.00	284	$0.00	$0.00	126	$0.00	$0.00	221	$0.00	$0.00	32	$0.00
UT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	9	$0.00	$0.00	2	$0.00
VA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	38	$0.00	$0.00	17	$0.00	$0.00	29	$0.00	$0.00	5	$0.00
VT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
WA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	42	$0.00	$0.00	19	$0.00	$0.00	33	$0.00	$0.00	5	$0.00
WI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	12	$0.00	$0.00	6	$0.00	$0.00	10	$0.00	$0.00	2	$0.00
WV	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	3	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
WY	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00

CLIN 2004 Supplemental Reports
CLIN 2004 Supplemental Reports	$	1700

CLIN 2005 File Review Surgical
CLIN 2005 File Review Surgical (1-200 Pages)	$	330
CLIN 2005 File Review Surical (101-250 Pages)	$	330
CLIN 2005 File Review Surgical (250+ Pages)	$	330

CLIN 2006 File Review--Impariment Rating
CLIN 2006 File Review-Impariment Rating (1-200 Pages)	$	200
CLIN 2006 File Review-Impairment Rating (101-250 Pages)	$	200
CLIN 2006 File Review- Impairment Rating (250+ Pages)	$	200

CLIN 2007 File Review Other
CLIN 2007 File Review Other (1-200 Pages)	$	200
CLIN 2007 File Review Other (101-250 Pages)	$	200
CLIN 2007 File Review Other (250+ Pages)	$	200

CLIN 2008 Travel/Transportation
CLIN 2008 Travel/Transportation	Pay-As-Billed Per OWCP CPT Code

CLIN 2009 Other Direct Cost - Canceled Appointments, Interpretive Services, Diagnostic Tests, and all other ancillary services

CLIN 2009 Claimant No-Show/Government Cancelations less than 24 hour notice	Billed/Paid at the fixed rate of $200 Per OWCP CPT Code
CLIN 2009 Interpreter Services	Pay-As-Billed Per OWCP CPT Code
CLIN 2009 Diagnostic Tests	Billed/Paid Per OWCP Fee Schedule
CLIN 2009 All other ancillary services	Billed/Paid Per OWCP Fee Schedule

Option Period 3

RFP 1605C3-25-R-00007 - Directed Medical Services for the Division of Federal Employees Compensation
State/Location	Internal Medicine	Estimated Quantity	Projected Value	Orthopedic surgery	Estimated Quantity	Projected Value	Pulmonary Medicine	Estimated Quantity	Projected Value	Otolaryngology	Estimated Quantity	Projected Value	Neurology	Estimated Quantity	Projected Value	Psychiatry	Estimated Quantity	Projected Value	Othter Specialists	Estimated Quantity	Projected Value
Possessions	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
Territories	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
Trust Territories	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
AK	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
AL	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	34	$0.00	$0.00	16	$0.00	$0.00	27	$0.00	$0.00	4	$0.00
AR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	21	$0.00	$0.00	10	$0.00	$0.00	16	$0.00	$0.00	3	$0.00
AZ	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	32	$0.00	$0.00	14	$0.00	$0.00	25	$0.00	$0.00	4	$0.00
CA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	21	$0.00	$0.00	186	$0.00	$0.00	83	$0.00	$0.00	145	$0.00	$0.00	21	$0.00
CT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	8	$0.00	$0.00	2	$0.00
CO	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	22	$0.00	$0.00	10	$0.00	$0.00	17	$0.00	$0.00	3	$0.00
DC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
DE	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	4	$0.00	$0.00	6	$0.00	$0.00	1	$0.00
FL North	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	13	$0.00	$0.00	110	$0.00	$0.00	49	$0.00	$0.00	85	$0.00	$0.00	13	$0.00
FL Central	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
FL South	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
GA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	73	$0.00	$0.00	33	$0.00	$0.00	57	$0.00	$0.00	9	$0.00
HI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	17	$0.00	$0.00	8	$0.00	$0.00	14	$0.00	$0.00	2	$0.00
IA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
ID	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
IL	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	10	$0.00	$0.00	86	$0.00	$0.00	39	$0.00	$0.00	67	$0.00	$0.00	10	$0.00
IN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	13	$0.00	$0.00	6	$0.00	$0.00	10	$0.00	$0.00	2	$0.00
KS	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
KY	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	23	$0.00	$0.00	11	$0.00	$0.00	18	$0.00	$0.00	3	$0.00
LA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	42	$0.00	$0.00	19	$0.00	$0.00	33	$0.00	$0.00	5	$0.00
MA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	35	$0.00	$0.00	16	$0.00	$0.00	27	$0.00	$0.00	4	$0.00
MD	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	72	$0.00	$0.00	32	$0.00	$0.00	56	$0.00	$0.00	8	$0.00
ME	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	4	$0.00	$0.00	6	$0.00	$0.00	1	$0.00
MI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	30	$0.00	$0.00	14	$0.00	$0.00	24	$0.00	$0.00	4	$0.00
MN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	8	$0.00	$0.00	2	$0.00
MO	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	22	$0.00	$0.00	10	$0.00	$0.00	18	$0.00	$0.00	3	$0.00
MS	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	4	$0.00	$0.00	7	$0.00	$0.00	1	$0.00
MT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
NC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	7	$0.00	$0.00	57	$0.00	$0.00	25	$0.00	$0.00	44	$0.00	$0.00	7	$0.00
ND	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
NE	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
NH	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
NJ	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	33	$0.00	$0.00	15	$0.00	$0.00	26	$0.00	$0.00	4	$0.00
NM	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
NV	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	15	$0.00	$0.00	7	$0.00	$0.00	12	$0.00	$0.00	2	$0.00
NY (Upstate)	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	12	$0.00	$0.00	105	$0.00	$0.00	47	$0.00	$0.00	82	$0.00	$0.00	12	$0.00
NY (Downstate)	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
OH	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	51	$0.00	$0.00	23	$0.00	$0.00	40	$0.00	$0.00	6	$0.00
OK	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	51	$0.00	$0.00	23	$0.00	$0.00	40	$0.00	$0.00	6	$0.00
OR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	14	$0.00	$0.00	7	$0.00	$0.00	11	$0.00	$0.00	2	$0.00
PA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	49	$0.00	$0.00	22	$0.00	$0.00	38	$0.00	$0.00	6	$0.00
PR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
RI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	4	$0.00	$0.00	7	$0.00	$0.00	1	$0.00
SC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	25	$0.00	$0.00	11	$0.00	$0.00	20	$0.00	$0.00	3	$0.00
SD	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
TN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	25	$0.00	$0.00	11	$0.00	$0.00	19	$0.00	$0.00	3	$0.00
TX	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	32	$0.00	$0.00	284	$0.00	$0.00	126	$0.00	$0.00	221	$0.00	$0.00	32	$0.00
UT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	9	$0.00	$0.00	2	$0.00
VA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	38	$0.00	$0.00	17	$0.00	$0.00	29	$0.00	$0.00	5	$0.00
VT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
WA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	42	$0.00	$0.00	19	$0.00	$0.00	33	$0.00	$0.00	5	$0.00
WI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	12	$0.00	$0.00	6	$0.00	$0.00	10	$0.00	$0.00	2	$0.00
WV	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	3	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
WY	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00

CLIN 3004 Supplemental Reports
CLIN 3004 Supplemental Reports	$	1700

CLIN 3005 File Review Surgical
CLIN 3005 File Review Surgical (1-300 Pages)	$	330
CLIN 3005 File Review Surical (101-250 Pages)	$	330
CLIN 3005 File Review Surgical (250+ Pages)	$	330

CLIN 3006 File Review--Impariment Rating
CLIN 3006 File Review-Impariment Rating (1-300 Pages)	$	200
CLIN 3006 File Review-Impairment Rating (101-250 Pages)	$	200
CLIN 3006 File Review- Impairment Rating (250+ Pages)	$	200

CLIN 3007 File Review Other
CLIN 3007 File Review Other (1-300 Pages)	$	200
CLIN 3007 File Review Other (101-250 Pages)	$	200
CLIN 3007 File Review Other (250+ Pages)	$	200

CLIN 3008 Travel/Transportation
CLIN 3008 Travel/Transportation	Pay-As-Billed Per OWCP CPT Code

CLIN 3009 Other Direct Cost - Canceled Appointments, Interpretive Services, Diagnostic Tests, and all other ancillary services

CLIN 3009 Claimant No-Show/Government Cancelations less than 24 hour notice	Billed/Paid at the fixed rate of $200 Per OWCP CPT Code
CLIN 3009 Interpreter Services	Pay-As-Billed Per OWCP CPT Code
CLIN 3009 Diagnostic Tests	Billed/Paid Per OWCP Fee Schedule
CLIN 3009 All other ancillary services	Billed/Paid Per OWCP Fee Schedule

Option Period 4

RFP 1605C3-25-R-00007 - Directed Medical Services for the Division of Federal Employees Compensation
State/Location	Internal Medicine	Estimated Quantity	Projected Value	Orthopedic surgery	Estimated Quantity	Projected Value	Pulmonary Medicine	Estimated Quantity	Projected Value	Otolaryngology	Estimated Quantity	Projected Value	Neurology	Estimated Quantity	Projected Value	Psychiatry	Estimated Quantity	Projected Value	Othter Specialists	Estimated Quantity	Projected Value
Possessions	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
Territories	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
Trust Territories	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
AK	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
AL	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	34	$0.00	$0.00	16	$0.00	$0.00	27	$0.00	$0.00	4	$0.00
AR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	21	$0.00	$0.00	10	$0.00	$0.00	16	$0.00	$0.00	3	$0.00
AZ	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	32	$0.00	$0.00	14	$0.00	$0.00	25	$0.00	$0.00	4	$0.00
CA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	21	$0.00	$0.00	186	$0.00	$0.00	83	$0.00	$0.00	145	$0.00	$0.00	21	$0.00
CT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	8	$0.00	$0.00	2	$0.00
CO	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	22	$0.00	$0.00	10	$0.00	$0.00	17	$0.00	$0.00	3	$0.00
DC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
DE	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	4	$0.00	$0.00	6	$0.00	$0.00	1	$0.00
FL North	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	13	$0.00	$0.00	110	$0.00	$0.00	49	$0.00	$0.00	85	$0.00	$0.00	13	$0.00
FL Central	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
FL South	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
GA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	73	$0.00	$0.00	33	$0.00	$0.00	57	$0.00	$0.00	9	$0.00
HI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	17	$0.00	$0.00	8	$0.00	$0.00	14	$0.00	$0.00	2	$0.00
IA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
ID	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
IL	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	10	$0.00	$0.00	86	$0.00	$0.00	39	$0.00	$0.00	67	$0.00	$0.00	10	$0.00
IN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	13	$0.00	$0.00	6	$0.00	$0.00	10	$0.00	$0.00	2	$0.00
KS	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
KY	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	23	$0.00	$0.00	11	$0.00	$0.00	18	$0.00	$0.00	3	$0.00
LA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	42	$0.00	$0.00	19	$0.00	$0.00	33	$0.00	$0.00	5	$0.00
MA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	35	$0.00	$0.00	16	$0.00	$0.00	27	$0.00	$0.00	4	$0.00
MD	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	72	$0.00	$0.00	32	$0.00	$0.00	56	$0.00	$0.00	8	$0.00
ME	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	8	$0.00	$0.00	4	$0.00	$0.00	6	$0.00	$0.00	1	$0.00
MI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	30	$0.00	$0.00	14	$0.00	$0.00	24	$0.00	$0.00	4	$0.00
MN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	8	$0.00	$0.00	2	$0.00
MO	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	22	$0.00	$0.00	10	$0.00	$0.00	18	$0.00	$0.00	3	$0.00
MS	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	4	$0.00	$0.00	7	$0.00	$0.00	1	$0.00
MT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
NC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	7	$0.00	$0.00	57	$0.00	$0.00	25	$0.00	$0.00	44	$0.00	$0.00	7	$0.00
ND	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
NE	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
NH	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	2	$0.00	$0.00	3	$0.00	$0.00	1	$0.00
NJ	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	4	$0.00	$0.00	33	$0.00	$0.00	15	$0.00	$0.00	26	$0.00	$0.00	4	$0.00
NM	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	3	$0.00	$0.00	5	$0.00	$0.00	1	$0.00
NV	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	15	$0.00	$0.00	7	$0.00	$0.00	12	$0.00	$0.00	2	$0.00
NY (Upstate)	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	12	$0.00	$0.00	105	$0.00	$0.00	47	$0.00	$0.00	82	$0.00	$0.00	12	$0.00
NY (Downstate)	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
OH	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	51	$0.00	$0.00	23	$0.00	$0.00	40	$0.00	$0.00	6	$0.00
OK	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	51	$0.00	$0.00	23	$0.00	$0.00	40	$0.00	$0.00	6	$0.00
OR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	14	$0.00	$0.00	7	$0.00	$0.00	11	$0.00	$0.00	2	$0.00
PA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	6	$0.00	$0.00	49	$0.00	$0.00	22	$0.00	$0.00	38	$0.00	$0.00	6	$0.00
PR	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	2	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
RI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	9	$0.00	$0.00	4	$0.00	$0.00	7	$0.00	$0.00	1	$0.00
SC	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	25	$0.00	$0.00	11	$0.00	$0.00	20	$0.00	$0.00	3	$0.00
SD	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
TN	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	3	$0.00	$0.00	25	$0.00	$0.00	11	$0.00	$0.00	19	$0.00	$0.00	3	$0.00
TX	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	32	$0.00	$0.00	284	$0.00	$0.00	126	$0.00	$0.00	221	$0.00	$0.00	32	$0.00
UT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	11	$0.00	$0.00	5	$0.00	$0.00	9	$0.00	$0.00	2	$0.00
VA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	38	$0.00	$0.00	17	$0.00	$0.00	29	$0.00	$0.00	5	$0.00
VT	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00
WA	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	42	$0.00	$0.00	19	$0.00	$0.00	33	$0.00	$0.00	5	$0.00
WI	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	12	$0.00	$0.00	6	$0.00	$0.00	10	$0.00	$0.00	2	$0.00
WV	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	5	$0.00	$0.00	3	$0.00	$0.00	4	$0.00	$0.00	1	$0.00
WY	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	2	$0.00	$0.00	1	$0.00	$0.00	1	$0.00	$0.00	1	$0.00

CLIN 4004 Supplemental Reports
CLIN 4004 Supplemental Reports	$	1700

CLIN 4005 File Review Surgical
CLIN 4005 File Review Surgical (1-400 Pages)	$	330
CLIN 4005 File Review Surical (101-250 Pages)	$	330
CLIN 4005 File Review Surgical (250+ Pages)	$	330

CLIN 4006 File Review--Impariment Rating
CLIN 4006 File Review-Impariment Rating (1-400 Pages)	$	200
CLIN 4006 File Review-Impairment Rating (101-250 Pages)	$	200
CLIN 4006 File Review- Impairment Rating (250+ Pages)	$	200

CLIN 4007 File Review Other
CLIN 4007 File Review Other (1-400 Pages)	$	200
CLIN 4007 File Review Other (101-250 Pages)	$	200
CLIN 4007 File Review Other (250+ Pages)	$	200

CLIN 4008 Travel/Transportation
CLIN 4008 Travel/Transportation	Pay-As-Billed Per OWCP CPT Code

CLIN 4009 Other Direct Cost - Canceled Appointments, Interpretive Services, Diagnostic Tests, and all other ancillary services

CLIN 4009 Claimant No-Show/Government Cancelations less than 24 hour notice	Billed/Paid at the fixed rate of $200 Per OWCP CPT Code
CLIN 4009 Interpreter Services	Pay-As-Billed Per OWCP CPT Code
CLIN 4009 Diagnostic Tests	Billed/Paid Per OWCP Fee Schedule
CLIN 4009 All other ancillary services	Billed/Paid Per OWCP Fee Schedule

File details come from the government source that posted it. Updated Sep 18, 2025.