Attachment_13_Pricing_Document-BAFO.xlsx
XLSX spreadsheet 31 KB Posted
- Attached to
- Master Agreement AZ|CTR073226
- Contract number
- CTR073226
- Issued by
- Arizona
About this file
This document appears to be a comprehensive pricing attachment for medical examination and assessment services, specifically Attachment 13 and 14 of a state and local contract indefinite delivery vehicle. The pricing document covers a wide range of medical examinations, testing, and diagnostic services for various professional certifications and occupational health screenings, including firefighter exams, correctional officer fitness exams, commercial driver's license assessments, peace officer evaluations, and specialized health screenings for hazardous material exposure.
The pricing document details unit prices for multiple medical services, including general medical exams ($5-$350 per exam), specific professional exams, vision and hearing tests ($10-$40), lung function tests ($45), cardiac assessments ($60-$360), laboratory tests ($30-$225), immunizations ($35-$4,000), drug and alcohol testing ($20-$60 per test), and on-site medical professional hourly rates ($50-$190). The contract offers extensive pricing for different types of medical examinations, lab work, drug screenings, and specialty tests across various professional categories, with pricing structured as per-exam or per-test rates. The document provides a comprehensive pricing schedule that appears designed to support medical screening and assessment needs for public safety and professional workforce health evaluations.
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Other files
| File | Type | Posted |
|---|---|---|
| 01.01.26_COI_AL_WC.pdf | ||
| 7-1-25_COI_GL.pdf | ||
| Attachment_08_Organization_Profile-COMPLETED.docx | DOCX document | |
| Listing_of_all_Service_Locations.xlsx | XLSX spreadsheet | |
| 1-1-25_COI_AL_WC.pdf | ||
| 7-1-25_COI_Cyber.pdf | ||
| Attachment_12_Business_Associates_Addendum__HIPAA_-FILLED_-_Copy.pdf | ||
| CTR073226_Banner_Health_Employee_Med_Exam_Svcs.pdf | ||
| CTR073226_Contract_Amendment__2.pdf | ||
| 07.01.26_COI_GL.pdf | ||
| Attachment_09_Service_Locations-Completed.xlsx | XLSX spreadsheet | |
| CTR073226_Contract_Amendment__1.pdf |
Show all 12
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Text version
Medical Exams & Assessments
| Medical Exams & Assessments | Quant. | Unit | Price |
| General Medical Exam | |||
| Review of Health History | 1 | Each | 5.00 |
| Physical Examination including a Musculoseketal Exam | 1 | Each | 120.00 |
| Completion of the Medical Examination form | 1 | Each | 5.00 |
| Vision Test (Pricing on Additional Testing Tab) | |||
| Audiogram (Pricing on Additional Testing Tab) | |||
| Urinalysis (dip) (Pricing on Lab Test Tab) | |||
| Firefigher Exam (Pre-Employment or Baseline Exam) | |||
| Review of Medical History (including OSHA Respiratiory Questionnaire and/or Hazmat Questionnaire if applicable) | 1 | Each | 30.00 |
| Physical Examination with Flexibility, Fitness testing (Push-ups, plank) Body Fat Analysis | 1 | Each | 75.00 |
| Completion of the Medical Examination form | 1 | Each | 5.00 |
| Far Vision Only (Corrected and Uncorrected), Color, Peripheral,Depth Perception (Pricing on Additional Testing Tab) | |||
| Audiogram (500 Hz - 8000 Hz) (Pricing on Additional Testing Tab) | |||
| Pulmonary Function Test/Spirometry (Pricing on Additional Testing Tab) | |||
| EKG (12 lead with interpretation) (Pricing on Additional Testing Tab) | |||
| TB Skin Test and Reading (Pricing on Additional Testing Tab) | |||
| PA/Lateral Chest X-ray (Pricing on Additional Testing Tab) | |||
| Treadmill Stress Test (Pricing on Additional Testing Tab) | |||
| Lab Test Required (Pricing on Lab Test Tab) a) Complete Blood Count and Differential |
b) Lipid Panel (Total Cholesterol, HDL, LDL)
c) BUN, Creatinine
d) Hemoglobin A1C lab test
e) Liver Function Test
f) Prostate-Specific Antigen (PSA) test g) Urinalysis (dip)
| Correctional Officer Fitness Exam | |||
| Review of Medical History | 1 | Each | 5.00 |
| Physical Examination that includes a hernia test, musculoskeletal evaluation, and Phalen’s or Tinel’s test | 1 | Each | 120.00 |
| Completion of the Medical Examination form | 1 | Each | 5.00 |
| Vision Test: Acuity, Horizontal Field and Color Perception (Pricing on Additional Testing Tab) | |||
| Audiogram (500 Hz - 8000 Hz) (Pricing on Additional Testing Tab) | |||
| Pulmonary Function Test/Spirometry (Pricing on Additional Testing Tab) | |||
| Lab Test Required (Pricing on Lab Test Tab) a) Complete Blood Count and Differential |
b) Lipid Panel (Total Cholesterol, HDL, LDL)
c) BUN, Creatinine
d) Hemoglobin A1C lab test
e) Liver Function Test f) Urinalysis (dip)
| USDOT Commercial Driver License Exam | |||
| Review of Medical History | 1 | Each | Included |
| Physical Examination | 1 | Each | 95.00 |
| Completion of the Medical Examination form | 1 | Each | Included |
| Vision Test: Acuity, Horizontal Field and Color Perception (Pricing on Additional Testing Tab) | |||
| Audiogram (500 Hz - 2000 Hz) (Pricing on Additional Testing Tab) | |||
| Lab Test Required (Pricing on Lab Test Tab) a) Federally Regulated Urine Drug Screen Panel b) Urinalysis (dip) | |||
| Arizona Peace Officer Standards Training (AZPOST) Exam | |||
| Review of Medical History | 1 | Each | 5.00 |
| Physical Examination | 1 | Each | 140.00 |
| Completion of the Medical Examination form | 1 | Each | 5.00 |
| Vision Test: Acuity, Horizontal Field and Color Perception (Pricing on Additional Testing Tab) | |||
| Audiogram (500 Hz - 8000 Hz) (Pricing on Additional Testing Tab) | |||
| Respirator Fitness Testing or Medical Particulate Mask (N95) Fit Testing | |||
| A discussion with the individual about his/her history as disclosed on the Health History and Physical Examination portions of the General Exam form | 1 | Each | $5.00 |
| Perform a physical assessment to determine the individual’s ability to use a respirator or N95 mask. | 1 | Each | $30.00 |
| Completion of assessment form | 1 | Each | $5.00 |
| Pulmonary Function Test/Spirometry (Pricing on Additional Testing Tab) | |||
| Asbestos Physical Assessment | |||
| Review of medical and work history | 1 | Each | $5.00 |
| Comprehensive Medical Exam | 1 | Each | $120.00 |
| Completion of Medical Assessment form | 1 | Each | $5.00 |
| Chest X-ray B-Read/Interpretation (Pricing on Additional Testing Tab) | |||
| Pulmonary Function Test/Spirometry (Pricing on Additional Testing Tab) | |||
| Lead Exposure Assessment | |||
| Review of medical history | 1 | Each | $25.00 |
| An assessment of teeth, mouth, skin, neurological status and vital signs | 1 | Each | $65.00 |
| Written statement indicating any evidence of lead-related health problems in accordance with 29 CFR OSHA1910.1025 (j). | 1 | Each | $5.00 |
| Lab Test Required (Pricing on Lab Test Tab) a) A blood lead and zinc protoporphyrin (ZPP) blood test | |||
| HAZWOPER/Hazardous Material Physical | |||
| Review of medical and work history | 1 | Each | $25.00 |
| Comprehensive Medical Exam | 1 | Each | $120.00 |
| Completion of assessment form | 1 | Each | $5.00 |
| Vision Test: Acuity, Horizontal Field and Color Perception (Pricing on Additional Testing Tab) | |||
| Audiogram (500 Hz - 2000 Hz) (Pricing on Additional Testing Tab) | |||
| Spirometry | |||
| Lab Test Required (Pricing on Lab Test Tab) a) CBD b) Urinalysis (dip) c) Liver Function test | |||
| Human Performance Evaluation | |||
| Review of medical and work history | 1 | Each | $5.00 |
| Comprehensive Medical Exam | 1 | Each | $120.00 |
| Evaluation of functional tasks, such as lifting, carrying, pushing, and pullin | 1 | Each | $75.00 |
| Completion of assessment form | 1 | Each | 5.00 |
| Fitness for Duty Exam | |||
| Review of medical and work history | 1 | Each | $10.00 |
| Comprehensive Medical Exam | 1 | Each | $350.00 |
| Completion of assessment form | 1 | Each | 5.00 |
| Labs and testing as needed |
&"Arial,Bold"Attachment 14 - Pricing Document
Additional Testing
| Additional Testing | Quant. | Unit | Price |
| Vision | |||
| Vision Test: Titmus type (Snellen Wall vision) | 1 | Each | $30.00 |
| Vision Test: Acuity, Horizontal Field and Color Perception | 1 | Each | $10.00 |
| Far Vision Only (Corrected and Uncorrected), Color, Peripheral,Depth Perception | 1 | Each | $25.00 |
| Hearing | |||
| Audiogram (500 Hz - 2000 Hz) | 1 | Each | $40.00 |
| Audiogram (500 Hz - 8000 Hz) | 1 | Each | $40.00 |
| Lung Function | |||
| Spirometry | 1 | Each | $45.00 |
| Pulmonary Function Test | 1 | Each | $45.00 |
| Chest X-ray B-Read/Interpretation | 1 | Each | $200.00 |
| Chest X-ray PA and Lateral Phys Component Two (2) Views | 1 | Each | $115.00 |
| Chest X-ray PA and Lateral with radiologist component | 1 | Each | $125.00 |
| Chest x-ray, one view, with radiologist component | 1 | Each | $115.00 |
| Cardiac Function | |||
| EKG (12 lead with interpretation) resting | 1 | Each | $60.00 |
| Maximal Treadmill Stress Test w/cardiologist interpretation | 1 | Each | $360.00 |
| Treadmill Submaximal/Stepmill | 1 | Each | $270.00 |
| Fitness Test: Step Test | 1 | Each | $30.00 |
| Lift test for 50 pounds | 1 | Each | $75.00 |
&"Arial,Bold"Attachment 14 - Pricing Document
Lab Tests
| Lab Tests | Quant. | Unit | Price* |
| Urine Test | |||
| Urinalysis (dip stick) | 1 | Each | $10.00 |
| Urinalysis | 1 | Each | $30.00 |
| Blood Test | |||
| Complete Blood Count and Differential | 1 | Each | $40.00 |
| SMAC-29 | 1 | Each | $40.00 |
| Chemistry 23 screen | 1 | Each | $40.00 |
| BUN, Creatinine | 1 | Each | $30.00 |
| Liver Function Test | 1 | Each | $60.00 |
| Hepatitis Panel | 1 | Each | $90.00 |
| Lipid Panel (Total Cholesterol, HDL, LDL) | 1 | Each | $40.00 |
| Comprehensive Metabolic Panel | 1 | Each | $40.00 |
| Hemoglobin A1C lab test | 1 | Each | $80.00 |
| Prostate-Specific Antigen (PSA) test | 1 | Each | $35.00 |
| Blood lead and zinc protoporphyrin (ZPP) blood test | 1 | Each | $90.00 |
| Heavy Metal Blood: arsenic, lead, zinc protopporphyrin, mercury, and cadmium (As/Cd/Hg/Pb/Zpp) | 1 | Each | $225.00 |
| Hepatitis Profile lab test (Hep A ab, Hep B ab, ag & Hep C ab) | 1 | Each | $90.00 |
| Hepatitis B Surface Antibody Quant | 1 | Each | $40.00 |
| Hepatitis C Antibody | 1 | Each | $95.00 |
| Anti-HAV (IGG/IGM) | 1 | Each | $70.00 |
| Anti-HCV (Hepatitis C) | 1 | Each | $95.00 |
| HiV Screen | 1 | Each | $115.00 |
| HIV-EIA | 1 | Each | $115.00 |
| L-MMR Titer | 1 | Each | $80.00 |
| Syphilis (RPR) | 1 | Each | $70.00 |
| Rapid Plasma Reagin, Qualitative | 1 | Each | $190.00 |
* Lab Test pricing shall include collection fees
&"Arial,Bold"Attachment 14 - Pricing Document
Immunizations & Treatments
| Immunizations and Treatments | Quant. | Unit | Price |
| TB Test | |||
| TB Skin Test and Reading | 1 | Each | $30.00 |
| T-SPOT TB test | 1 | Each | $85.00 |
| Immunizations | |||
| Varicella Zoster, per dose | 1 | Each | $75.00 |
| Varicella booster | 1 | Each | $190.00 |
| MMR virus Injection Vaccine | 1 | Each | $105.00 |
| Hepatitis A & B Vaccine Twinrix | 1 | Each | $160.00 |
| Hep B Recombivax, 3-Shot Series | 1 | Each | $105.00 |
| Hepatitis B Immune Globulin Shot | 1 | Each | market value |
| Influenza Vaccine | 1 | Each | $35.00 |
| TDaP Vaccine | 1 | Each | $70.00 |
| Tetanus Vaccine, per dose | 1 | Each | $60.00 |
| Rabies Treatment | |||
| Rabies Blood Work (Titer check) | 1 | Each | $195.00 |
| Rabies Booster Shot | 1 | Each | $460.00 |
| Rabies Post-Exposure vaccinations, 2-Shot series with previous pre-exposure treatment | 1 | Each | NA |
| Rabies Post-Exposure vaccinations, 5-Shot series with HRIG for non pre-exposure treatment | 1 | Each | $4,000.00 |
| Rabies Pre-Exposure vaccinations; 3-Shot Series | 1 | Each | $460.00 |
&"Arial,Bold"Attachment 14 - Pricing Document
Other Fees
| Other Fees | Quant. | Unit | Price |
| Hourly rate for Physician to perform physicals onsite at State Facility | 1 | Hr. | $190.00 |
| Hourly rate for Physician Assistant to perform physicals onsite at State Facility | 1 | Hr. | $90.00 |
| Hourly rate for Nurse Practitioner to perform physicals onsite at State Facility | 1 | Hr. | $90.00 |
| Hourly rate for Medical Assistant to help with physicals onsite at State Facility | 1 | Hr. | $50.00 |
&"Arial,Bold"Attachment 14 - Pricing Document
Drug & Alcohol Testing
| Drug Testing | Quant. | Unit | Price |
| Urine Testing | |||
| Non-Observed Collection Services | 1 | Each | $40.00 |
| Observed Collection Services | 1 | Each | $30.00 |
| Federally Regulated Drug Screen Panel | 1 | Test | $57.25 |
| Five (5) Panel Urine Drug Screen: Amphetamines, Cannabinoids (THC), Cocaine, Opiates, Phencyclidine (PCP) | 1 | Test | $55.00 |
| Seven (7) Panel Urine Drug Screen: Amphetamines, Benzodiazepines, Barbiturates, Cannabinoids (THC), Cocaine, Opiates, Phencyclidine (PCP) | 1 | Test | $57.50 |
| Nine (9) Panel Urine Drug Screen: Amphetamines, Benzodiazepines, Barbiturates, Cannabinoids (THC), Cocaine, Methadone, Opiates, Phencyclidine (PCP), Propoxyphene (e.g. Darvon) | 1 | Test | $60.00 |
| Fentanyl Urine Drug Screen | 1 | Test | $20.00 |
| Oxycodone Drug Screen | 1 | Test | $20.00 |
| Nitazene Urine Drug Screen | 1 | Test | $70.00 |
| EtG Urine Alcohol Test | 1 | Test | $20.00 |
| Confirmation testing on positive test result | 1 | Test | Included |
| Saliva Testing | |||
| Federally Regulated Drug Screen Panel | 1 | Test | $57.25 |
| Five (5) Panel Drug Screen: Amphetamines, Cannabinoids (THC), Cocaine, Opiates, Phencyclidine (PCP) | 1 | Test | $55.00 |
| Seven (7) Panel Drug Screen: Amphetamines, Benzodiazepines, Barbiturates, Cannabinoids (THC), Cocaine, Opiates, Phencyclidine (PCP) | 1 | Test | $57.50 |
| Nine (9) Panel Drug Screen: Amphetamines, Benzodiazepines, Barbiturates, Cannabinoids (THC), Cocaine, Methadone, Opiates, Phencyclidine (PCP), Propoxyphene (e.g. Darvon) | 1 | Test | $60.00 |
| Fentanyl Drug Screen | 1 | Test | $20.00 |
| Oxycodone Drug Screen | 1 | Test | $20.00 |
| Nitazene Drug Screen | 1 | Test | $70.00 |
| Alcohol Saliva Test | 1 | Test | $20.00 |
| Confirmation testing on positive test result | 1 | Test | Included |
| Breath Alcohol Testing | |||
| BAT Test | 1 | Test | $40.00 |
&"Arial,Bold"Attachment 14 - Pricing Document
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