Attmt__23_Pricing_Worksheet_for_FY19.xlsx
XLSX spreadsheet 18 KB Posted
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- Pre-employment and Employee Medical Services
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- HSBP1013R0033
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Attachment 23 Pricing Worksheet
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Proposed FY2019
| FY2019 (PRE-EMPLOYMENT AND EMPLOYEE MEDICAL SERVICES) | |||
| Item No. | Description | Estimated Expected | |
| Quantity | Unit | Unit | |
| Price | Total |
Estimated $
| 00001 | Pre-employment Medical Services | ||
| A | Pre-employment drug test - all positions | 1625 | each |
| B | Pre-employment onsite drug test - all positions | 1 | each |
| C | Pre-employment modified-onsite drug test - all positions | 1 | each |
| D | Pre-employment medical exam/drug test combination | 1 | each |
| E | Pre-employment medical exam - all positions | 7285 | each |
| F | Chest Xray (single view) | 583 | each |
| G | Non-Psychiatric Consultation | ||
| 1 | Non-Psychiatric Level I Consultation | 449 | each |
| 2 | Non-Psychiatric Level II Consultation | 449 | each |
| 3 | Non-Psychiatric Level III Specialist Consultation | 90 | each |
| H | Psychiatric Specialist Consultation - all positions | ||
| 1 | Psychiatric Level I Consultation | 1 | each |
| 2 | Psychiatric Level II Consultation | 1 | each |
| 3 | Psychiatric Level III Consultation | 1 | each |
| I | Physician legal consult/testimony | 8 | per hour |
| J | Physician travel for legal consult/testimony | 6 | per hour |
| K | Travel (i.e.meetings) | 8 | each |
| Pre-Employment Total |
| 00002 | Employee Medical Services | ||
| A | Employee medical examination (including physician review) | 75 | each |
| 1 | No show fee for employee medical examination | 4 | each |
| B | IME (including physician review) | 40 | Lot |
| 1 | Rescheduling Fee | 75 | each |
| 2 | No show fee | 10 | each |
| C | Psychiatric IME (including physician review) | 38 | each |
| D | Medical Hardship Reassignment I | 13 | each |
| E | Medical Hardship Reassignment II | 13 | each |
| F | Non-Psychiatric Consultation | ||
| 1 | Non-Psychiatric Level I Consultation | 25 | each |
| 2 | Non-Psychiatric Level II Consultation | 75 | each |
| 3 | Non-Psychiatric Level III Specialist Consultation | 100 | each |
| G | Psychiatric Specialist Consultation - all positions | ||
| 1 | Psychiatric Level I Consultation | 1 | each |
| 2 | Psychiatric Level II Consultation | 1 | each |
| 3 | Psychiatric Level III Consultation | 1 | each |
| H | CDL Exams | 24 | each |
| I | Travel (i.e.meetings) | 5 | each |
| J | Physician legal consult/testimony | 25 | per hour |
| K | IME physician legal consult/testimony | 5 | each |
| Employee Services Total |
| 00003 | Employee Drug Testing Services | ||
| A | Random on-site | 2250 | each |
| B | Random off-site/ Random network | 750 | each |
| C | Reasonable Suspicion | 10 | each |
| D | Post Accident (unsafe practice) | 20 | each |
| E | Return-to-duty/follow-up | 25 | each |
| Employee Drug Testing Services Total |
| 00004 | Additional Tests | ||
| A | Chest X-Ray (single view) | 3 | each |
| B | TB Skin Test (with chest x-ray if indicated) | 3 | each |
| C | Audiometry | 3 | each |
| D | Height and Weight | 3 | each |
| E | Lab Profile: CBC with differential, CHEM profile, Urinalysis | 3 | each |
| F | Resting EKG with interpretation | 3 | each |
| G | Visual Acuity (Corrected and uncorrected, near and distance) | 3 | each |
| H | Vital Signs | 3 | each |
| I | Thyroid Stimulating Hormone (TSH) w/Reflex Free T4 | 3 | each |
| J | Hemoglobin A1C (HgBA1C) | 3 | each |
| K | Blood Glucose | 3 | each |
| L | Blood Lead Level | 3 | each |
| M | Cardiac Risk Profile | 3 | each |
| N | Chest X-Ray (PA and Lateral) | 3 | each |
| O | Color Vision Assessment | 3 | each |
| P | Maximal Stress EKG with MD interpretation | 3 | each |
| Q | Peripheral Vision and Visual Depth Perception | 3 | each |
| R | Protoporphyrin, Zinc (ZPP) Blood Test | 3 | each |
| S | Resting 12 Lead EKG with MD Interpretation | 3 | each |
| T | Spirometry (FVC%, FEV1, FEV1/FVC%) | 3 | each |
| U | Blood Alcohol Test | 3 | each |
| V | Exercise Stress Echo | 3 | each |
| W | Echocardiogram | 3 | each |
| X | Sleep study | 3 | each |
| Y | Functional capacity Evaluation (FCE) | 3 | each |
| Z | Additional Testing for IME per Medicare Cost Schedule | 10 | each |
| Additional Tests Total |
| 00005 | Information Technology Services | ||
| A | Security Authorization and Monitoring | 1 | each |
| Information Technology Services Total |
FY2019 Total
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