Exhibit_B-1_-_Rate_Sheet_Fillable.xlsx
XLSX spreadsheet 43 KB Posted
- Attached to
- C5613378-D, Staff Medical Monitoring Services
- Solicitation number
- 0000039417
- Issued by
- California
About this file
This is a Rate Sheet (Exhibit B-1) for a Staff Medical Monitoring Services contract issued by the California Department of Corrections and Rehabilitation (CDCR), Bid Number C5613378-D. The contract encompasses medical examination and testing services across three regional groups serving CDCR institutions, fire conservation camps, facilities, parole offices, and programs. Services include physical examinations for respiratory protection, lead work, asbestos exposure, hazardous substances, chromium, cadmium, audiograms, commercial driver certifications, and aerosol transmissible disease clearances. The contract also includes individual medical and test services such as spirometry, blood chemistry panels, various laboratory tests, vaccinations, and medications. Additional services encompass physician consultations, site mobilization, bloodborne pathogen screening and training, lockbox maintenance, and travel expenses. Bidders may submit bids for one or more of the three regional groups (Northern, Central, or Southern Region) but must provide rates for all items within any selected group. The estimated contract value is capped at $30,000,000 for the entire term, and each participating location includes a 25% line item allowance for additional as-needed, unforeseeable services.
Compensation shall be based on the rates specified in the Rate Sheet, which must include all labor, transportation, materials, supplies, equipment, permits, licenses, taxes, and fees necessary to perform services. Bidders must complete all highlighted cells in the Excel version and cannot leave any cells blank; blank cells may result in bid rejection. A zero dollar amount indicates the bidder will perform services at no cost to the State. All prices must be provided in U.S. currency, printed in ink or typewritten. The State estimates quantities for bid comparison purposes only and reserves the right to increase or omit work portions as deemed necessary. Upon approval of items not specifically identified in the Rate Sheet, contractors will be reimbursed for actual cost plus 20% and applicable taxes, with cost substantiation required per Exhibit A. Contractors may offer early payment discounts of at least 1% or minimum $50.00 for invoices paid within 30 days of receipt; in case of tie bids, CDCR reserves the right to award based on discount percentage, or alternatively, use a coin toss or lot drawing. There is no guarantee that any services will be requested under this agreement.
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Summary
| STAFF MEDICAL MONITORING SERVICES |
| Electronic bid packages include an Excel version of this Rate Sheet (Exhibit B-1) in addition to the PDF file in order to assist bidders in computing accurate totals. Bidders should download the Excel version and complete ALL highlighted cells. |
The Contractor will be compensated for services performed in accordance with the applicable rate(s) specified in Exhibit B-1, Rate Sheet which shall include all labor, personnel, transportation (including travel, per diem, fuel, and mileage), materials, supplies, tools, any necessary equipment, permits, licenses, taxes, fees, shipping/freight charges, and every other item of expense necessary (unless otherwise specified herein) in accordance with the CDCR/CCHCS institutions, fire conservation camps, facilities, parole offices, and programs listed in Exhibit F, List of Participating Locations, hereafter referred to as Worksite.
Bidders may bid on one or more groups. Bidders are not required to bid on all groups; however, bidders must include a rate for all items within that group. Failure to indicate a dollar amount (blank cell) on any item may be grounds to reject the entire bid for that location. A zero dollar amount ($0.00 or $ -) listed for any and/or all items shall be interpreted and understood by the State to mean that the bidder will perform any such services at NO COST to the State.
Any and all services performed outside the scope of this Agreement shall be at the sole risk and expense of the Contractor. All prices and notations must be printed in ink or typewritten. All prices must be bid in U.S. currency and shall encompass every item of expense necessary to perform the services.
Quantities and services listed in the Exhibit B-1, Rate Sheet are the State's estimates only and are offered as a basis for the comparison of bids. The State does not expressly or by implication agree that the actual amount of work will correspond therewith and reserves the right to increase/omit portions of the work as may be deemed necessary or advisable by the State.
Each participating location’s total basis of award includes a Rate Sheet line item totaling 25% of the sum of the bidder’s service rate(s) to allow for additional as-needed, unforeseeable services. As-needed services will be payable at the applicable service rate(s) on the Exhibit B-1, Rate Sheet.
All CDCR estimated quantities and Contractor provided rates are for the entire term of this agreement.
| Upon approval of any items not specifically identified in Exhibit B-1, Rate Sheet, the Contractor will be reimbursed for actual cost plus 20% and applicable taxes. The Contractor must include cost substantiation as specified in Exhibit A, Scope of Work. | |
| Contractors may offer a discount on invoices received and accepted by CDCR and paid within thirty (30) days of receipt. Discount offered must be at least one percent of the invoice amount and a minimum of $50.00. | |
| Discount offered on invoices paid within 30 days of receipt = | * |
| *In the event of tie bids, CDCR reserves the right to determine the bidder entitled to the contract award based on the percentage of discount. If not applicable or a discount tie, a coin toss or lot drawing will be used in accordance with the Invitation for Bid, Basis for Award. |
NOTE: There are no guarantees that any services will be requested from this agreement.
| TOTAL BASIS FOR AWARD** | |
| GROUP 1 - NORTHERN REGION | $ - 0 |
| GROUP 2 - CENTRAL REGION | $ - 0 |
| GROUP 3 - SOUTHERN REGION | $ - 0 |
**The 'Total Basis for Award' is strictly used for bidding purposes only and is used to determine the lowest responsible bidder.
THE STATE ESTIMATES THE TOTAL AMOUNT OF THIS AGREEMENT SHALL NOT EXCEED
$30,000,000.00 (THIRTY MILLION DOLLARS AND ZERO CENTS) AND SHALL BE WRITTEN FOR THAT AMOUNT.
&"Arial,Regular" California Department of Corrections and Rehabilitation (CDCR) Rate Sheet &"Arial,Regular"Bid Number C5613378-D Exhibit B-1
&"Arial,Regular"Page &P of &N
Group 1
GROUP 1 - NORTHERN REGION:
Antelope Conservation Camp (CC #25), California Health Care Facility (CHCF), California Medical Facility (CMF), Deadwood Conservation Camp (CC #23), Delta Conservation Camp (CC #8), Eel River Conservation Camp (CC #31), Folsom State Prison (FSP), Growlersburg Conservation Camp (CC #33), High Desert State Prison (HDSP), Intermountain Conservation Camp (CC #22), Ishi Conservation Camp (CC #18), Konocti Conservation Camp (CC #27), Mule Creek State Prison (MCSP), Parlin Fork Conservation Center (CC #6), Pelican Bay State Prison (PBSP), Pine Grove Conservation Camp (CC#12) , California State Prison, Sacramento (SAC), Salt Creek Conservation Camp (CC #7), Sierra Conservation Center (SCC), California State Prison, Solano (SOL), San Quentin Rehabilitation Center (SQ), Sugar Pine Conservation Camp (CC #9), Trinity River Conservation Camp (CC #3), Vallecito Conservation Camp (CC #1), Washington Ridge Conservation Camp (CC #44), CDCR-Headquarters (CDCR- HQ), Division of Adult Parole Operations-Headquarters (DAPO- HQ), DAPO-Northern Region (DAPO-No. Reg.), Division of Adult Institutions (DAI), Facilities, Planning, Construction and Management (FPCM), Correctional Construction Mentorship – Region I (CCM Reg I), Peace Officer Selection and Employee Development (POSED)
| A. PHYSICAL EXAMINATION (ITEMS 1-13) | |||
| SERVICE DESCRIPTION | CPT | RATE | |
| 1 | RESPIRATORY PROTECTION EXAMINATION - CCR 5144 - Medical Evaluations: Administration and review of the Respirator Medical Evaluation Questionnaire contained in CCR, Title 8, Section 5144(e) and Appendix C; or use a medical examination that obtains the same information. Evaluation of responses by a physician or other licensed health care professional (PLHCP). Determination of medical fitness to use a respirator and specify types of respirator (e.g. N95, half-face, full-face, PAPR, SCBA). |
Evaluating PLHCP to provide a written statement regarding the ability to use a respirator including any limitations and types of respirators. The evaluation must be valid up to 4 years and be clearly marked with an expiry date. Respirator Medical Evaluation Questionnaire must be a web based software or application.
| If unable to provide medical clearance via Respirator Medical Evaluation Questionnaire, must provide Follow-Up Medical Examination. | 99202 | |||
| 2 | RESPIRATORY PROTECTION EXAMINATION - CCR 5144 - Follow-Up Medical Examinations: Conduct additional medical examinations when required based on questionnaire responses, including but not limiting to physical examinations, pulmonary function testing, and any other diagnostic testing deemed neccessary. Evaluating PLHCP to provide a written statement regarding the ability to use a respirator including any limitations and types of respirators. The evaluation must be valid up to 4 years and be clearly marked with an expiry date. | 99204 | ||
| 3 | LEAD MEDICAL EXAMINATION - CCR 1532.1/5198: Physical Exam, Blood Chemistry Panel, Blood Lead, CBC, Zinc Protoporphrin, Blood Urea Nitrogen, Serum Creatinine, Urinalysis, Letter of Clearance regarding the employee's ability to perform Lead Work including ability to wear a respirator. | 99204, 80050, 83655, 85025, 84202, 84520, 82565, 81001 | ||
| 4 | ABESTOS MEDICAL EXAMINATION - CCR 1529/5208: Physical Exam, Spirometry, Chest X-ray, Letter of Clearance regarding employee's ability to perform Asbestos work including ability to wear a respirator. | 99204, 94010, 71030 | ||
| 5 | HAZARDOUS SUBSTANCE EXAMINATION - CCR 5192: Physical Exam, Spirometry, Letter of Clearance regarding the employee's ability to perform Hazardous Materials work and ability to wear an air purifying respirator or self contained breathing apparatus. | 99204, 94010 | ||
| 6 | CHROMIUM MEDICAL EXAMINATION - CCR 1532.2/5206: Physical Exam and Letter of Clearance relative to Chromium work and ability to wear a respirator. | 99204 | ||
| 7 | CADMIUM INITIAL EXAMINATION - CCR 1532/5207: Physical Exam, Cadmium in Urine (CdU), standardized to grams of creatinine (g/Cr), Beta-2 microglobulin in urine (ß2 -M), standardized to grams of creatinine (g/Cr), with pH specified, standardized to grams of creatinine (g/Cr), Cadmium in blood (CdB), standardized to liters of whole blood (lwb). Letter of Clearance. | 99204, 82300, 82232 | ||
| 8 | CADMIUM PERIODIC MEDICAL SURVEILLANCE - CCR 1532/5207: Physical Exam, Chest X-ray, Pulmonary function tests, Cadmium in urine (CdU), standardized to grams of creatinine (g/Cr), Beta-2 microglobulin in urine (ß2 -M), standardized to grams of creatinine (g/Cr) with pH specified, standardized to grams of creatinine (g/Cr), Cadmium in blood (CdB), standardized to liters of whole blood (lwb). Blood Urea Nitrogen, Complete Blood Count, and Serum Creatinine. Urinalysis including the determination of albumin, glucose and total and low molecular weight proteins. Prostate Palpation. Letter of Clearance. | 99204, 71010, 94010, 82300, 82232, 84520, 85025, 82565, 81000 | ||
| 9 | CADMIUM MEDICAL EXAMINATION FOR RESPIRATOR USE - CCR 1532/5207: Physical Exam including blood pressure test, Cadmium in Urine (CdU) standardized to grams of creatinine (g/Cr), Beta-2 microglobulin in urine (ß2 -M), standardized to grams of creatinine (g/Cr), with pH specified standardized to grams of creatinine (g/Cr), Cadmium in blood (CdB), standardized to liters of whole blood (lwb). Letter of Clearance to wear a respirator. | 99204, 82300, 82232 | ||
| 10 | AUDIOGRAM - CCR 1597: Physical Exam to establish a baseline audiogram for employees exposed at or about the action level, Report of audiometric test results. | 92552 | ||
| 11 | CALIFORNIA COMMERCIAL DRIVERS EXAMINATION - 49CFR391.41 - 391.49 & CVC 12517.2 - Physical examination including visual acuity, hearing, blood pressure, pulse rate, urinalysis, etc., and complete CA DMV DL 51. | 99204, 81000 | ||
| 12 | AEROSOL TRANSMISSIBLE DISEASE - CCR 5199: Physical Exam and Letter of Clearance to return to work (w/wo restricted activity). | 99204 | ||
| 13 | ARREST AND FIREARMS TRAINING COURSE - CCR 1059 - PC 832 COURSE - Physical Exam and Letter of Clearance to to particpate in the PC 832 training course required by CCR 1059. The Physical Exam should include current and pre-existing medical conditions if applicable. | |||
| TOTAL FOR SECTION (A) | $ - 0 | |||
| B. INDIVIDUAL MEDICAL/TEST SERVICES (ITEMS 14-62) | CPT | RATE | ||
| 14 | Spirometry Testing | 94010 | ||
| 15 | Blood Chemistry Panel | 80050 | ||
| 16 | Blood Lead Levels | 83655 | ||
| 17 | Blood Chemistry CBC | 85025 | ||
| 18 | Zinc Protoporphrin Test | 84202 | ||
| 19 | Blood Urea Nitrogen Test | 84520 | ||
| 20 | Serum Creatinine Test | 92565 | ||
| 21 | Urinalysis Exam-automated, microscopy | 81001 | ||
| 22 | Resting EKG | 93000 | ||
| 23 | Exercise/Stress EKG | 93015 | ||
| 24 | Chest X-ray read by a B Reader | 71030 | ||
| 25 | Cadmium in urine | 82300 | ||
| 26 | Beta-2 microglobulin in urine | 82232 | ||
| 27 | Cadmium in blood | 82300 | ||
| 28 | Chest X-ray-single view | 71010 | ||
| 29 | Urinalysis Exam | 81000 | ||
| 30 | Audiogram | 92552 | ||
| 31 | Chickenpox Immunity Screening-IgG | 82784 | ||
| 32 | Varicella (Chickenpox) Vaccine | 90716 | ||
| 33 | Measles Immunity Screen | 82784 | ||
| 34 | Measles/Mumps/Rubella Vaccine | 90707 | ||
| 35 | Liver Panel - SGPT and SGOT | 80076 | ||
| 36 | T-dap (Tetanus/Diphtheria/Pertussis) Vaccine | 90715 | ||
| 37 | Pregnancy Test | 84703 | ||
| 38 | Male Fertility Test | 89310 | ||
| 39 | Stool Guaiac | 82270 | ||
| 40 | Limited Follow-up Exam. Established Patient | 99213 | ||
| 41 | Detailed Follow-up Exam. Established Patient | 99214 | ||
| 42 | Quantitative Fit Testing | N/A | ||
| 43 | Hepatitis B Vaccine | 90746 | ||
| 44 | HIV Test | 86701 | ||
| 45 | HIV Blood Draw | 36415 | ||
| 46 | Bloodborne Pathogen Assessment | 99214 | ||
| 47 | Laboratory Services (As Requested) | N/A | ||
| 48 | Hepatitis B Surface Antigen | 87340 | ||
| 49 | Hepatitis B Surface Antibody Titer | 86317 | ||
| 50 | Hepatitis C Antibody | 86803 | ||
| 51 | Hepatitis B Antigen Test | 87340 | ||
| 52 | Mumps Immunity Screening | 86735 | ||
| 53 | Rubella immunity Screening | 86762 | ||
| 54 | Hepatitis B Core Antibody Test | 86705 | ||
| 55 | Truvada (Single Pill-Blister Pack)-Medication | N/A | ||
| 56 | Raltegravir (25 mg)-Medication | N/A | ||
| 57 | Oseltamivir (75 mg)-Medication | N/A | ||
| 58 | Isoniazid (300 mg)-Medication | N/A | ||
| 59 | Rifapentine (150 mg)- Medication | N/A | ||
| 60 | Pyridoxine (50 mg)-Medication | N/A | ||
| 61 | Post Exposure Follow Up Consultation (hourly rate) | N/A | ||
| 62 | Reporting Contact Investigation (Exhibit A-3(a) Summary Report of Case Contact Investigation) (hourly rate) | N/A | ||
| TOTAL FOR SECTION (B): | $ - 0 |
| C. ADDITIONAL SERVICES (ITEMS 63-68) | CPT | RATE | |
| 63 | Physician Consultation (hourly rate) | N/A | |
| 64 | Medical Examination Team - Site Mobilization (per individual) | N/A | |
| 65 | Blood Borne Pathogen (BBP) Screening and Training (per individual, per test rate) | N/A | |
| 66 | Maintenance of Lockbox/Medications (annual rate) | N/A | |
| 67 | Worksite Approved Lockbox (estimated max $1,000) | N/A | $ 1,000.00 |
| 68 | Travel-Per Camp Site per Visit (estimated max $500) | N/A | $ 500.00 |
| TOTAL FOR SECTION (C): | $ - 0 |
| TOTAL FOR SECTIONS (A + B + C): | $ - 0 |
| AVERAGE RATE FOR GROUP 1 - NORTHERN REGION (TOTAL BASIS OF AWARD): | $ - 0 |
&"Arial,Regular" California Department of Corrections and Rehabilitation (CDCR) Rate Sheet &"Arial,Regular"Bid Number C5613378-D
&"Arial,Regular"Page &P of &N
Group 2
GROUP 2 - CENTRAL REGION:
Avenal State Prison (ASP), Ben Lomond Conservation Camp (CC #45), California Correctional Institution (CCI), Central California Women's Facility (CCWF), California Men's Colony (CMC), California State Prison, Corcoran (COR), Correctional Training Facility (CTF), Cuesta Conservation Camp (CC #24), Gabilan Conservation Camp (CC #38), Kern Valley State Prison (KVSP), Miramonte Conservation Camp (CC #5), Mount Bullion Conservation Camp (CC #39), Mountain Home Conservation Camp (CC #10), North Kern State Prison (NKSP), Owens Valley Conservation Camp (CC #26), Pleasant Valley State Prison (PVSP), California Substance Abuse Treatment Facility and State Prison at Corcoran (SATF), Salinas Valley State Prison (SVSP), Valley State Prison (VSP), Wasco State Prison (WSP), Correctional Construction Mentorship – Region II (CCM Reg II)
| A. PHYSICAL EXAMINATION (ITEMS 1-13) | |||
| SERVICE DESCRIPTION | CPT | RATE | |
| 1 | RESPIRATORY PROTECTION EXAMINATION - CCR 5144 - Medical Evaluations: Administration and review of the Respirator Medical Evaluation Questionnaire contained in CCR, Title 8, Section 5144(e) and Appendix C; or use a medical examination that obtains the same information. Evaluation of responses by a physician or other licensed health care professional (PLHCP). Determination of medical fitness to use a respirator and specify types of respirator (e.g. N95, half-face, full-face, PAPR, SCBA). |
Evaluating PLHCP to provide a written statement regarding the ability to use a respirator including any limitations and types of respirators. The evaluation must be valid up to 4 years and be clearly marked with an expiry date. Respirator Medical Evaluation Questionnaire must be a web based software or application.
| If unable to provide medical clearance via Respirator Medical Evaluation Questionnaire, must provide Follow-Up Medical Examination. | 99202 | |||
| 2 | RESPIRATORY PROTECTION EXAMINATION - CCR 5144 - Follow-Up Medical Examinations: Conduct additional medical examinations when required based on questionnaire responses, including but not limiting to physical examinations, pulmonary function testing, and any other diagnostic testing deemed neccessary. Evaluating PLHCP to provide a written statement regarding the ability to use a respirator including any limitations and types of respirators. The evaluation must be valid up to 4 years and be clearly marked with an expiry date. | 99204 | ||
| 3 | LEAD MEDICAL EXAMINATION - CCR 1532.1/5198: Physical Exam, Blood Chemistry Panel, Blood Lead, CBC, Zinc Protoporphrin, Blood Urea Nitrogen, Serum Creatinine, Urinalysis, Letter of Clearance regarding the employee's ability to perform Lead Work including ability to wear a respirator. | 99204, 80050, 83655, 85025, 84202, 84520, 82565, 81001 | ||
| 4 | ABESTOS MEDICAL EXAMINATION - CCR 1529/5208: Physical Exam, Spirometry, Chest X-ray, Letter of Clearance regarding employee's ability to perform Asbestos work including ability to wear a respirator. | 99204, 94010, 71030 | ||
| 5 | HAZARDOUS SUBSTANCE EXAMINATION - CCR 5192: Physical Exam, Spirometry, Letter of Clearance regarding the employee's ability to perform Hazardous Materials work and ability to wear an air purifying respirator or self contained breathing apparatus. | 99204, 94010 | ||
| 6 | CHROMIUM MEDICAL EXAMINATION - CCR 1532.2/5206: Physical Exam and Letter of Clearance relative to Chromium work and ability to wear a respirator. | 99204 | ||
| 7 | CADMIUM INITIAL EXAMINATION - CCR 1532/5207: Physical Exam, Cadmium in Urine (CdU), standardized to grams of creatinine (g/Cr), Beta-2 microglobulin in urine (ß2 -M), standardized to grams of creatinine (g/Cr), with pH specified, standardized to grams of creatinine (g/Cr), Cadmium in blood (CdB), standardized to liters of whole blood (lwb). Letter of Clearance. | 99204, 82300, 82232 | ||
| 8 | CADMIUM PERIODIC MEDICAL SURVEILLANCE - CCR 1532/5207: Physical Exam, Chest X-ray, Pulmonary function tests, Cadmium in urine (CdU), standardized to grams of creatinine (g/Cr), Beta-2 microglobulin in urine (ß2 -M), standardized to grams of creatinine (g/Cr) with pH specified, standardized to grams of creatinine (g/Cr), Cadmium in blood (CdB), standardized to liters of whole blood (lwb). Blood Urea Nitrogen, Complete Blood Count, and Serum Creatinine. Urinalysis including the determination of albumin, glucose and total and low molecular weight proteins. Prostate Palpation. Letter of Clearance. | 99204, 71010, 94010, 82300, 82232, 84520, 85025, 82565, 81000 | ||
| 9 | CADMIUM MEDICAL EXAMINATION FOR RESPIRATOR USE - CCR 1532/5207: Physical Exam including blood pressure test, Cadmium in Urine (CdU) standardized to grams of creatinine (g/Cr), Beta-2 microglobulin in urine (ß2 -M), standardized to grams of creatinine (g/Cr), with pH specified standardized to grams of creatinine (g/Cr), Cadmium in blood (CdB), standardized to liters of whole blood (lwb). Letter of Clearance to wear a respirator. | 99204, 82300, 82232 | ||
| 10 | AUDIOGRAM - CCR 1597: Physical Exam to establish a baseline audiogram for employees exposed at or about the action level, Report of audiometric test results. | 92552 | ||
| 11 | CALIFORNIA COMMERCIAL DRIVERS EXAMINATION - 49CFR391.41 - 391.49 & CVC 12517.2 - Physical examination including visual acuity, hearing, blood pressure, pulse rate, urinalysis, etc., and complete CA DMV DL 51. | 99204, 81000 | ||
| 12 | AEROSOL TRANSMISSIBLE DISEASE - CCR 5199: Physical Exam and Letter of Clearance to return to work (w/wo restricted activity). | 99204 | ||
| 13 | ARREST AND FIREARMS TRAINING COURSE - CCR 1059 - PC 832 COURSE - Physical Exam and Letter of Clearance to to particpate in the PC 832 training course required by CCR 1059. The Physical Exam should include current and pre-existing medical conditions if applicable. | |||
| TOTAL FOR SECTION (A) | $ - 0 | |||
| B. INDIVIDUAL MEDICAL/TEST SERVICES (ITEMS 14-62) | CPT | RATE | ||
| 14 | Spirometry Testing | 94010 | ||
| 15 | Blood Chemistry Panel | 80050 | ||
| 16 | Blood Lead Levels | 83655 | ||
| 17 | Blood Chemistry CBC | 85025 | ||
| 18 | Zinc Protoporphrin Test | 84202 | ||
| 19 | Blood Urea Nitrogen Test | 84520 | ||
| 20 | Serum Creatinine Test | 92565 | ||
| 21 | Urinalysis Exam-automated, microscopy | 81001 | ||
| 22 | Resting EKG | 93000 | ||
| 23 | Exercise/Stress EKG | 93015 | ||
| 24 | Chest X-ray read by a B Reader | 71030 | ||
| 25 | Cadmium in urine | 82300 | ||
| 26 | Beta-2 microglobulin in urine | 82232 | ||
| 27 | Cadmium in blood | 82300 | ||
| 28 | Chest X-ray-single view | 71010 | ||
| 29 | Urinalysis Exam | 81000 | ||
| 30 | Audiogram | 92552 | ||
| 31 | Chickenpox Immunity Screening-IgG | 82784 | ||
| 32 | Varicella (Chickenpox) Vaccine | 90716 | ||
| 33 | Measles Immunity Screen | 82784 | ||
| 34 | Measles/Mumps/Rubella Vaccine | 90707 | ||
| 35 | Liver Panel - SGPT and SGOT | 80076 | ||
| 36 | T-dap (Tetanus/Diphtheria/Pertussis) Vaccine | 90715 | ||
| 37 | Pregnancy Test | 84703 | ||
| 38 | Male Fertility Test | 89310 | ||
| 39 | Stool Guaiac | 82270 | ||
| 40 | Limited Follow-up Exam. Established Patient | 99213 | ||
| 41 | Detailed Follow-up Exam. Established Patient | 99214 | ||
| 42 | Quantitative Fit Testing | N/A | ||
| 43 | Hepatitis B Vaccine | 90746 | ||
| 44 | HIV Test | 86701 | ||
| 45 | HIV Blood Draw | 36415 | ||
| 46 | Bloodborne Pathogen Assessment | 99214 | ||
| 47 | Laboratory Services (As Requested) | N/A | ||
| 48 | Hepatitis B Surface Antigen | 87340 | ||
| 49 | Hepatitis B Surface Antibody Titer | 86317 | ||
| 50 | Hepatitis C Antibody | 86803 | ||
| 51 | Hepatitis B Antigen Test | 87340 | ||
| 52 | Mumps Immunity Screening | 86735 | ||
| 53 | Rubella immunity Screening | 86762 | ||
| 54 | Hepatitis B Core Antibody Test | 86705 | ||
| 55 | Truvada (Single Pill-Blister Pack)-Medication | N/A | ||
| 56 | Raltegravir (25 mg)-Medication | N/A | ||
| 57 | Oseltamivir (75 mg)-Medication | N/A | ||
| 58 | Isoniazid (300 mg)-Medication | N/A | ||
| 59 | Rifapentine (150 mg)- Medication | N/A | ||
| 60 | Pyridoxine (50 mg)-Medication | N/A | ||
| 61 | Post Exposure Follow Up Consultation (hourly rate) | N/A | ||
| 62 | Reporting Contact Investigation (Exhibit A-3(a) Summary Report of Case Contact Investigation) (hourly rate) | N/A | ||
| TOTAL FOR SECTION (B): | $ - 0 |
| C. ADDITIONAL SERVICES (ITEMS 63-68) | CPT | RATE | |
| 63 | Physician Consultation (hourly rate) | N/A | |
| 64 | Medical Examination Team - Site Mobilization (per individual) | N/A | |
| 65 | Blood Borne Pathogen (BBP) Screening and Training (per individual, per test rate) | N/A | |
| 66 | Maintenance of Lockbox/Medications (annual rate) | N/A | |
| 67 | Worksite Approved Lockbox (estimated max $1,000) | N/A | $ 1,000.00 |
| 68 | Travel-Per Camp Site per Visit (estimated max $500) | N/A | $ 500.00 |
| TOTAL FOR SECTION (C): | $ - 0 |
| TOTAL FOR SECTIONS (A + B + C): | $ - 0 |
| AVERAGE RATE FOR GROUP 2 - CENTRAL REGION (total basis for award): | $ - 0 |
&"Arial,Regular" California Department of Corrections and Rehabilitation (CDCR) Rate Sheet &"Arial,Regular"Bid Number C5613378-D
&"Arial,Regular"Page &P of &N
Group 3
GROUP 3 - SOUTHERN REGION:
Acton Conservation Camp (CC #11), Bautista Conservation Camp (CC #36), Calipatria State Prison (CAL), Centinela State Prison (CEN), California Institution for Men (CIM), California Institution for Women (CIW), California Rehabilitation Center (CRC), Fenner Canyon Conservation Camp (CC #41), Francisquito Conservation Camp (CC #4), Holton Conservation Camp (CC #16), Ironwood State Prison (ISP), Julius Klein Conservation Camp (CC #19), California State Prison, Los Angeles County (LAC), Malibu Conservation Camp (CC #13), Oak Glen Conservation Camp (CC #35), Prado Conservation Camp (CC #28), Puerta La Cruz Conservation Camp (CC #14), Richard J. Donovan Correctional Facility (RJD), Division of Adult Parole Operations-Southern Region (DAPO-So. Reg.), Correctional Construction Mentorship – Region III (CCM Reg III)
| A. PHYSICAL EXAMINATION (ITEMS 1-13) | |||
| SERVICE DESCRIPTION | CPT | RATE | |
| 1 | RESPIRATORY PROTECTION EXAMINATION - CCR 5144 - Medical Evaluations: Administration and review of the Respirator Medical Evaluation Questionnaire contained in CCR, Title 8, Section 5144(e) and Appendix C; or use a medical examination that obtains the same information. Evaluation of responses by a physician or other licensed health care professional (PLHCP). Determination of medical fitness to use a respirator and specify types of respirator (e.g. N95, half-face, full-face, PAPR, SCBA). |
Evaluating PLHCP to provide a written statement regarding the ability to use a respirator including any limitations and types of respirators. The evaluation must be valid up to 4 years and be clearly marked with an expiry date. Respirator Medical Evaluation Questionnaire must be a web based software or application.
| If unable to provide medical clearance via Respirator Medical Evaluation Questionnaire, must provide Follow-Up Medical Examination. | 99202 | |||
| 2 | RESPIRATORY PROTECTION EXAMINATION - CCR 5144 - Follow-Up Medical Examinations: Conduct additional medical examinations when required based on questionnaire responses, including but not limiting to physical examinations, pulmonary function testing, and any other diagnostic testing deemed neccessary. Evaluating PLHCP to provide a written statement regarding the ability to use a respirator including any limitations and types of respirators. The evaluation must be valid up to 4 years and be clearly marked with an expiry date. | 99204 | ||
| 3 | LEAD MEDICAL EXAMINATION - CCR 1532.1/5198: Physical Exam, Blood Chemistry Panel, Blood Lead, CBC, Zinc Protoporphrin, Blood Urea Nitrogen, Serum Creatinine, Urinalysis, Letter of Clearance regarding the employee's ability to perform Lead Work including ability to wear a respirator. | 99204, 80050, 83655, 85025, 84202, 84520, 82565, 81001 | ||
| 4 | ABESTOS MEDICAL EXAMINATION - CCR 1529/5208: Physical Exam, Spirometry, Chest X-ray, Letter of Clearance regarding employee's ability to perform Asbestos work including ability to wear a respirator. | 99204, 94010, 71030 | ||
| 5 | HAZARDOUS SUBSTANCE EXAMINATION - CCR 5192: Physical Exam, Spirometry, Letter of Clearance regarding the employee's ability to perform Hazardous Materials work and ability to wear an air purifying respirator or self contained breathing apparatus. | 99204, 94010 | ||
| 6 | CHROMIUM MEDICAL EXAMINATION - CCR 1532.2/5206: Physical Exam and Letter of Clearance relative to Chromium work and ability to wear a respirator. | 99204 | ||
| 7 | CADMIUM INITIAL EXAMINATION - CCR 1532/5207: Physical Exam, Cadmium in Urine (CdU), standardized to grams of creatinine (g/Cr), Beta-2 microglobulin in urine (ß2 -M), standardized to grams of creatinine (g/Cr), with pH specified, standardized to grams of creatinine (g/Cr), Cadmium in blood (CdB), standardized to liters of whole blood (lwb). Letter of Clearance. | 99204, 82300, 82232 | ||
| 8 | CADMIUM PERIODIC MEDICAL SURVEILLANCE - CCR 1532/5207: Physical Exam, Chest X-ray, Pulmonary function tests, Cadmium in urine (CdU), standardized to grams of creatinine (g/Cr), Beta-2 microglobulin in urine (ß2 -M), standardized to grams of creatinine (g/Cr) with pH specified, standardized to grams of creatinine (g/Cr), Cadmium in blood (CdB), standardized to liters of whole blood (lwb). Blood Urea Nitrogen, Complete Blood Count, and Serum Creatinine. Urinalysis including the determination of albumin, glucose and total and low molecular weight proteins. Prostate Palpation. Letter of Clearance. | 99204, 71010, 94010, 82300, 82232, 84520, 85025, 82565, 81000 | ||
| 9 | CADMIUM MEDICAL EXAMINATION FOR RESPIRATOR USE - CCR 1532/5207: Physical Exam including blood pressure test, Cadmium in Urine (CdU) standardized to grams of creatinine (g/Cr), Beta-2 microglobulin in urine (ß2 -M), standardized to grams of creatinine (g/Cr), with pH specified standardized to grams of creatinine (g/Cr), Cadmium in blood (CdB), standardized to liters of whole blood (lwb). Letter of Clearance to wear a respirator. | 99204, 82300, 82232 | ||
| 10 | AUDIOGRAM - CCR 1597: Physical Exam to establish a baseline audiogram for employees exposed at or about the action level, Report of audiometric test results. | 92552 | ||
| 11 | CALIFORNIA COMMERCIAL DRIVERS EXAMINATION - 49CFR391.41 - 391.49 & CVC 12517.2 - Physical examination including visual acuity, hearing, blood pressure, pulse rate, urinalysis, etc., and complete CA DMV DL 51. | 99204, 81000 | ||
| 12 | AEROSOL TRANSMISSIBLE DISEASE - CCR 5199: Physical Exam and Letter of Clearance to return to work (w/wo restricted activity). | 99204 | ||
| 13 | ARREST AND FIREARMS TRAINING COURSE - CCR 1059 - PC 832 COURSE - Physical Exam and Letter of Clearance to to particpate in the PC 832 training course required by CCR 1059. The Physical Exam should include current and pre-existing medical conditions if applicable. | |||
| TOTAL FOR SECTION (A) | $ - 0 | |||
| B. INDIVIDUAL MEDICAL/TEST SERVICES (ITEMS 14-62) | CPT | RATE | ||
| 14 | Spirometry Testing | 94010 | ||
| 15 | Blood Chemistry Panel | 80050 | ||
| 16 | Blood Lead Levels | 83655 | ||
| 17 | Blood Chemistry CBC | 85025 | ||
| 18 | Zinc Protoporphrin Test | 84202 | ||
| 19 | Blood Urea Nitrogen Test | 84520 | ||
| 20 | Serum Creatinine Test | 92565 | ||
| 21 | Urinalysis Exam-automated, microscopy | 81001 | ||
| 22 | Resting EKG | 93000 | ||
| 23 | Exercise/Stress EKG | 93015 | ||
| 24 | Chest X-ray read by a B Reader | 71030 | ||
| 25 | Cadmium in urine | 82300 | ||
| 26 | Beta-2 microglobulin in urine | 82232 | ||
| 27 | Cadmium in blood | 82300 | ||
| 28 | Chest X-ray-single view | 71010 | ||
| 29 | Urinalysis Exam | 81000 | ||
| 30 | Audiogram | 92552 | ||
| 31 | Chickenpox Immunity Screening-IgG | 82784 | ||
| 32 | Varicella (Chickenpox) Vaccine | 90716 | ||
| 33 | Measles Immunity Screen | 82784 | ||
| 34 | Measles/Mumps/Rubella Vaccine | 90707 | ||
| 35 | Liver Panel - SGPT and SGOT | 80076 | ||
| 36 | T-dap (Tetanus/Diphtheria/Pertussis) Vaccine | 90715 | ||
| 37 | Pregnancy Test | 84703 | ||
| 38 | Male Fertility Test | 89310 | ||
| 39 | Stool Guaiac | 82270 | ||
| 40 | Limited Follow-up Exam. Established Patient | 99213 | ||
| 41 | Detailed Follow-up Exam. Established Patient | 99214 | ||
| 42 | Quantitative Fit Testing | N/A | ||
| 43 | Hepatitis B Vaccine | 90746 | ||
| 44 | HIV Test | 86701 | ||
| 45 | HIV Blood Draw | 36415 | ||
| 46 | Bloodborne Pathogen Assessment | 99214 | ||
| 47 | Laboratory Services (As Requested) | N/A | ||
| 48 | Hepatitis B Surface Antigen | 87340 | ||
| 49 | Hepatitis B Surface Antibody Titer | 86317 | ||
| 50 | Hepatitis C Antibody | 86803 | ||
| 51 | Hepatitis B Antigen Test | 87340 | ||
| 52 | Mumps Immunity Screening | 86735 | ||
| 53 | Rubella immunity Screening | 86762 | ||
| 54 | Hepatitis B Core Antibody Test | 86705 | ||
| 55 | Truvada (Single Pill-Blister Pack)-Medication | N/A | ||
| 56 | Raltegravir (25 mg)-Medication | N/A | ||
| 57 | Oseltamivir (75 mg)-Medication | N/A | ||
| 58 | Isoniazid (300 mg)-Medication | N/A | ||
| 59 | Rifapentine (150 mg)- Medication | N/A | ||
| 60 | Pyridoxine (50 mg)-Medication | N/A | ||
| 61 | Post Exposure Follow Up Consultation (hourly rate) | N/A | ||
| 62 | Reporting Contact Investigation (Exhibit A-3(a) Summary Report of Case Contact Investigation) (hourly rate) | N/A | ||
| TOTAL FOR SECTION (B): | $ - 0 |
| C. ADDITIONAL SERVICES (ITEMS 63-68) | CPT | RATE | |
| 63 | Physician Consultation (hourly rate) | N/A | |
| 64 | Medical Examination Team - Site Mobilization (per individual) | N/A | |
| 65 | Blood Borne Pathogen (BBP) Screening and Training (per individual, per test rate) | N/A | |
| 66 | Maintenance of Lockbox/Medications (annual rate) | N/A | |
| 67 | Worksite Approved Lockbox (estimated max $1,000) | N/A | $ 1,000.00 |
| 68 | Travel-Per Camp Site per Visit (estimated max $500) | N/A | $ 500.00 |
| TOTAL FOR SECTION (C): | $ - 0 |
| TOTAL FOR SECTIONS (A + B + C): | $ - 0 |
| AVERAGE RATE FOR GROUP 1 - SOUTHERN REGION (total basis for award): | $ - 0 |
&"Arial,Regular" California Department of Corrections and Rehabilitation (CDCR) Rate Sheet &"Arial,Regular"Bid Number C5613378-D
&"Arial,Regular"Page &P of &N
File details come from the government source that posted it. Updated .