PricematrixRFP0215156.xls

XLS spreadsheet 208 KB Posted May 15, 2009

Attached to: Pre-Employment and Fitness-For-Duty Physical Examinations
Solicitation number: RFP0215156
Issued by: Department of Justice Federal Bureau of Investigation Headquarters Division

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Other files

File	Type	Posted
SF33_a.XPW	XPW file	Jun 16, 2009
answers_to_vendor_questions06-16-09 lkc.doc	DOC document	Jun 16, 2009
Adjusted Physical RFP 06-16-09.xls	XLS spreadsheet	Jun 16, 2009
fd-979.pdf	PDF	May 15, 2009
fd-979.pdf	PDF	May 15, 2009
fd-866.pdf	PDF	May 15, 2009
SitevisitRFP0215156.doc	DOC document	May 15, 2009
fd-947.pdf	PDF	May 15, 2009
fd-985.pdf	PDF	May 15, 2009
fd-966.pdf	PDF	May 15, 2009
fd-951.pdf	PDF	May 15, 2009
fd-949.pdf	PDF	May 15, 2009
fd-945.pdf	PDF	May 15, 2009
Form1.xml	XML file	May 15, 2009
fd-864.pdf	PDF	May 15, 2009
SF-LLL.pdf	PDF	May 15, 2009
fd-900.pdf	PDF	May 15, 2009
fd-899.pdf	PDF	May 15, 2009
Attachment 32 FD816.txt	TXT text file	May 15, 2009
FD-868.xml	XML file	May 15, 2009
RFP 0215156 Physical Exams	—	May 15, 2009
fd-944.pdf	PDF	May 15, 2009
fd-960.pdf	PDF	May 15, 2009
fd-816.pdf	PDF	May 15, 2009
fd-963.pdf	PDF	May 15, 2009
fd-964.pdf	PDF	May 15, 2009
fd-943.pdf	PDF	May 15, 2009
fd-946.pdf	PDF	May 15, 2009
Attachment 33 fd-979.pdf	PDF	May 15, 2009
fd-995.pdf	PDF	May 15, 2009
fd-965.pdf	PDF	May 15, 2009
sf3881.pdf	PDF	May 15, 2009
sf93.pdf	PDF	May 15, 2009
Pdf version of dept state FD 300 forms.pdf	PDF	May 15, 2009
Attachment 34 PAST PERFORMANCE RATING SHEET.doc	DOC document	May 15, 2009
PricematrixRFP0215156.xls	XLS spreadsheet	May 15, 2009
sf88.pdf	PDF	May 15, 2009
fd-950.pdf	PDF	May 15, 2009
FD-967.xml	XML file	May 15, 2009
SitevisitRFP0215156.doc	DOC document	May 15, 2009
RFP 0215156 Physical Exams	—	May 15, 2009

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Boston

				Request for Proposal (RFP) - Pricing matrix
SECTION A						Date: 2/08
Boston
Vendor Name
POC Name				Phone Number
	Below is the estimate of the number of each exam per category per year
1.	Fitness-for-Duty Physical Examinations				160
2.	Pre-Employment (Applicant) Physical Examinations				72
3.	Cardiovascular (Stress) Tests				51
4.	FAA Physical Examinations (pilot)				9
5.	Language Specialists requiring Audiometer Testing				7
6.	LEGAT and Dependents Physical Examinations				4
7.	Hazardous Materials Response Unit (HMRU) Examinations				10
8.	Respiratory Clearance Examinations				25
9.	Hazardous Device School				1
10.	Department of Transportation (DOT) Physical Examinations (drivers)				1
11.	FBI Dive Examimations - Navy Dive Standards				1
SECTION B
1.		Fitness-for-Duty Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for performing one of this exam type refer to FD 943, section J
						$	$	$	$	$
2.		Pre-Employment Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for performing this exam, Refer to FD 945
						$	$	$	$	$
3.		Cardiovascular (Stress) Tests				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each test listed below
	Special Studies		a. Treadmill Bruce protocol			$	$	$	$	$
			b. Thallium SPECT Stress			$	$	$	$	$
			c. Echocardiogram, Stress			$	$	$	$	$
4.		FAA Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	(Must be conducted by certified FAA examiner)

Components are listed on FAA forms, see FD 963, section J

			FAA Class 1				$	$	$	$	$
			Class 2 Medical Certificate
5.		Language Specialists requiring Audiometer Testing					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Audiometer Testing						$	$	$	$	$
6.		LEGAT and Dependents Physical					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter total price for perfroming exam, Refer to FD 949, 50, 51, section J						$	$	$	$	$
7.		Hazardous Materials Response Unit (HMRU) Exam					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each component listed below, Refer to FD 944, 947						$	$	$	$	$
8.		Respiratory Clearance Exam					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 946, (support only, no agents)						$	$	$	$	$
9.		Hazardous Device School					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 965, Section J						$	$	$	$	$
10.		Department of Transportation (DOT) Physical					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 964, Section J						$	$	$	$	$
11.		FBI Dive Examinations - NAVY Dive Standards					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to , List of Attachments, FD 966, Section J						$	$	$	$	$
	Enter Total price per complete exam in colums K-O row 60 above
12.		Immunizations			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each injection listed below (price w & w/o FBI supplied serum)
Standard			a. Polio (IPV)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90713		$	$	$	$	$
			b. MMR booster (born 1957 +)
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90707		$	$	$	$	$
			c. Tetanus/Diptheria booster (every 10 years)
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90718		$	$	$	$	$
			d. Tdap tetanus/Diptheria/Pertussis
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90715		$	$	$	$	$
			e. Hepatitis A (per shot)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90632		$	$	$	$	$
			f. Hepatitis B (per shot)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90746		$	$	$	$	$
			g. Typhoid	i. Oral
				ii. admin w/ FBI serum	90473		$	$	$	$	$
				iii. Admin w/o FBI serum	90473/90690		$	$	$	$	$
			h. Typhoid	i. IM (every 2 yrs)
				ii. Admin w/FBI serum	90471		$	$	$	$	$
				iii. admin w/o FBI serum	90471/90691		$	$	$	$	$
			i. Influenza	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90658		$	$	$	$	$
Special Use			a. Meningococcal Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471 &		$	$	$	$	$
					90733 or 90734		$	$	$	$	$
			b. Yellow Fever	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90717		$	$	$	$	$
			c. Rabies Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			d. Japanese B Encephalitis	i. w/FBI supplied serum	90471		$	$	$	$	$
			d. Anthrax Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			e. Botulinum Toxin Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			f. Twinvax	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90636		$	$	$	$	$
Enter unit price of each immunization listed below
Malaria				i. Malarone
				* admin w/o FBI supplying	4120F		$	$	$	$	$
				ii. Doxycycline
				* admin w/o FBI supplying	4120F		$	$	$	$	$
				iii. Mefloquine
				* admin w/o FBI supplying	4120F		$	$	$	$	$
13.		Additional Individual Testing as Requested			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
			a. ALT		84460		$	$	$	$	$
			b. Audiometry		92551		$	$	$	$	$
			c. Blood group and type		86900, 01		$	$	$	$	$
			d. Blood Lead-age 9 mos. through 6 years		83655		$	$	$	$	$
			e. Blood renal and metabolic panels		80053		$	$	$	$	$
			f. Cardiologist over read of EKG		99499		$	$	$	$	$
			g. Chest X-ray, PA/LAT		71020		$	$	$	$	$
			h. Chest x-ray over read by radiologist		76499		$	$	$	$	$
			i. Colonoscopy - per approval		45378		$	$	$	$	$
			j. Complete blood count with diff		85025		$	$	$	$	$
			k. Complete GYN Exam w/ PAP as indicated		88141		$	$	$	$	$
			li. Completion of Respiratory Questionnaire		FD-900		$	$	$	$	$
			m. Creatinine		82565		$	$	$	$	$
			n. CXR - P/A and lateral		71020		$	$	$	$	$
			o. Digital Rectal Exam, Male > 40- offer		45999		$	$	$	$	$
			p. Distant and Near Visual Acuity, w & w/o correction		99172		$	$	$	$	$
			q. Electrocardiogram w/interpretation		93000		$	$	$	$	$
			r. Fasting Blood Glucose		82947		$	$	$	$	$
			s. Flexible Sigmoidoscopy - per approval		45330		$	$	$	$	$
			q. G6PD, if not previously done		82955		$	$	$	$	$
			r. GGT & Uric Acid		82977/84550		$	$	$	$	$	a. Urinalysis	81001
			t. HbA1C		83036		$	$	$	$	$	b. Stool for occult blood X 3 - offer	82270
			v. Hepatitis B Antibody and Antigen		87340/86706		$	$	$	$	$
			w. Hepatitis C antibody		86803		$	$	$	$	$
			x. History, physical exam, vitals, written summary		99395,96,97		$	$	$	$	$
			y. HIV, I & II Elisa		87390/87391		$	$	$	$	$
			z. IGRA as alternative to tubercullin skin tests				$	$	$	$	$
			aa. Influenza, annually		90658		$	$	$	$	$
			bb. Intraocular Tension (IOT) > 40 years of age		92120		$	$	$	$	$
			cc. Lead & ZPP (if authorized by HCPU)		84202/83655		$	$	$	$	$
			dd. Lipid panel		80061		$	$	$	$	$
			ee. Mammogram (as indicated)		77057		$	$	$	$	$
			ff. Mantoux skin test & interruptation		86580		$	$	$	$	$
			gg. Prostate specific antigen (PSA)		84153		$	$	$	$	$
			hh. Pulmonary function test		94010		$	$	$	$	$
			ii. RBC Cholinesterase x 1 draw		82482		$	$	$	$	$
			jj. Serology, RPR		86592		$	$	$	$	$
			kk. Sickle Cell-Mediterranean or Black only		85660		$	$	$	$	$
			ll. Stool for occult blood x's 3		82270		$	$	$	$	$
			mm. Stool for Ova & Parasites (as indicated)		87177		$	$	$	$	$
			nn. Tdap: Tetanus/diphtheria/pertussis every 10 yrs		90715		$	$	$	$	$
			ool. Tetanus/ diphtheria every 10 years or Tdap		90718		$	$	$	$	$
			pp. Tuberculin test & interpretation by medical prof		86580		$	$	$	$	$
			qq. UA and micro.		81001		$	$	$	$	$
			rr. Visual fields Strabismus, Color Vision		99172		$	$	$	$	$
14.		Hourly Rate for Expert Testimony			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
						99075	$	$	$	$	$
15.		Hourly Rate for Medical Consultation and Training					$	$	$	$	$
						99078
*		Total Pricing Per Year					$	$	$	$	$
**		Grand Total (all years)					$	$	$	$	$
		(Vitals include: ht, wt, B/P, pulse, respiration, temperature)

Philadelphia

				Request for Proposal (RFP) - Pricing matrix
SECTION A						Date: 2/08
Philadelphia
Vendor Name
POC Name				Phone Number
	Below is the estimate of the number of each exam per category per year
1.	Fitness-for-Duty Physical Examinations				118
2.	Pre-Employment (Applicant) Physical Examinations				80
3.	Cardiovascular (Stress) Tests				80
4.	FAA Physical Examinations (pilot)				1
5.	Language Specialists requiring Audiometer Testing				5
6.	LEGAT and Dependents Physical Examinations				3
7.	Hazardous Materials Response Unit (HMRU) Examinations				7
8.	Respiratory Clearance Examinations				5
9.	Hazardous Device School				1
10.	Department of Transportation (DOT) Physical Examinations (drivers)				2
11.	FBI Dive Examimations - Navy Dive Standards				1
SECTION B
1.		Fitness-for-Duty Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
		Enter unit price for performing one of this exam type refer to FD 943, section J
						$	$	$	$	$
2.		Pre-Employment Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
		Enter unit price for performing this exam, Refer to FD 945
						$	$	$	$	$
3.		Cardiovascular (Stress) Tests				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
		Enter unit price for each test listed below
		Special Studies	a. Treadmill Bruce protocol			$	$	$	$	$
			b. Thallium SPECT Stress			$	$	$	$	$
			c. Echocardiogram, Stress			$	$	$	$	$
4.		FAA Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	(Must be conducted by certified FAA examiner)

Components are listed on FAA forms, see FD 963, section J

			FAA Class 1				$	$	$	$	$
			Class 2 Medical Certificate
5.		Language Specialists requiring Audiometer Testing					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Audiometer Testing						$	$	$	$	$
6.		LEGAT and Dependents Physical					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter total price for perfroming exam, Refer to FD 949, 50, 51, section J						$	$	$	$	$
7.		Hazardous Materials Response Unit (HMRU) Exam					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each component listed below, Refer to FD 944, 947						$	$	$	$	$
8.		Respiratory Clearance Exam					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 946, (support only, no agents)						$	$	$	$	$
9.		Hazardous Device School					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 965, Section J						$	$	$	$	$
10.		Department of Transportation (DOT) Physical					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 964, Section J						$	$	$	$	$
11.		FBI Dive Examinations - NAVY Dive Standards					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to , List of Attachments, FD 966, Section J						$	$	$	$	$
	Enter Total price per complete exam in colums K-O row 60 above
12.		Immunizations			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each injection listed below (price w & w/o FBI supplied serum)
Standard			a. Polio (IPV)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90713		$	$	$	$	$
			b. MMR booster (born 1957 +)
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90707		$	$	$	$	$
			c. Tetanus/Diptheria booster (every 10 years)
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90718		$	$	$	$	$
			d. Tdap tetanus/Diptheria/Pertussis
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90715		$	$	$	$	$
			e. Hepatitis A (per shot)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90632		$	$	$	$	$
			f. Hepatitis B (per shot)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90746		$	$	$	$	$
			g. Typhoid	i. Oral
				ii. admin w/ FBI serum	90473		$	$	$	$	$
				iii. Admin w/o FBI serum	90473/90690		$	$	$	$	$
			h. Typhoid	i. IM (every 2 yrs)
				ii. Admin w/FBI serum	90471		$	$	$	$	$
				iii. admin w/o FBI serum	90471/90691		$	$	$	$	$
			i. Influenza	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90658		$	$	$	$	$
Special Use			a. Meningococcal Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471 &		$	$	$	$	$
					90733 or 90734		$	$	$	$	$
			b. Yellow Fever	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90717		$	$	$	$	$
			c. Rabies Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			d. Japanese B Encephalitis	i. w/FBI supplied serum	90471		$	$	$	$	$
			d. Anthrax Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			e. Botulinum Toxin Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			f. Twinvax	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90636		$	$	$	$	$
Enter unit price of each immunization listed below
Malaria				i. Malarone
				* admin w/o FBI supplying	4120F		$	$	$	$	$
				ii. Doxycycline
				* admin w/o FBI supplying	4120F		$	$	$	$	$
				iii. Mefloquine
				* admin w/o FBI supplying	4120F		$	$	$	$	$
13.		Additional Individual Testing as Requested			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
			a. ALT		84460		$	$	$	$	$
			b. Audiometry		92551		$	$	$	$	$
			c. Blood group and type		86900, 01		$	$	$	$	$
			d. Blood Lead-age 9 mos. through 6 years		83655		$	$	$	$	$
			e. Blood renal and metabolic panels		80053		$	$	$	$	$
			f. Cardiologist over read of EKG		99499		$	$	$	$	$
			g. Chest X-ray, PA/LAT		71020		$	$	$	$	$
			h. Chest x-ray over read by radiologist		76499		$	$	$	$	$
			i. Colonoscopy - per approval		45378		$	$	$	$	$
			j. Complete blood count with diff		85025		$	$	$	$	$
			k. Complete GYN Exam w/ PAP as indicated		88141		$	$	$	$	$
			li. Completion of Respiratory Questionnaire		FD-900		$	$	$	$	$
			m. Creatinine		82565		$	$	$	$	$
			n. CXR - P/A and lateral		71020		$	$	$	$	$
			o. Digital Rectal Exam, Male > 40- offer		45999		$	$	$	$	$
			p. Distant and Near Visual Acuity, w & w/o correction		99172		$	$	$	$	$
			q. Electrocardiogram w/interpretation		93000		$	$	$	$	$
			r. Fasting Blood Glucose		82947		$	$	$	$	$
			s. Flexible Sigmoidoscopy - per approval		45330		$	$	$	$	$
			q. G6PD, if not previously done		82955		$	$	$	$	$
			r. GGT & Uric Acid		82977/84550		$	$	$	$	$	a. Urinalysis	81001
			t. HbA1C		83036		$	$	$	$	$	b. Stool for occult blood X 3 - offer	82270
			v. Hepatitis B Antibody and Antigen		87340/86706		$	$	$	$	$
			w. Hepatitis C antibody		86803		$	$	$	$	$
			x. History, physical exam, vitals, written summary		99395,96,97		$	$	$	$	$
			y. HIV, I & II Elisa		87390/87391		$	$	$	$	$
			z. IGRA as alternative to tubercullin skin tests				$	$	$	$	$
			aa. Influenza, annually		90658		$	$	$	$	$
			bb. Intraocular Tension (IOT) > 40 years of age		92120		$	$	$	$	$
			cc. Lead & ZPP (if authorized by HCPU)		84202/83655		$	$	$	$	$
			dd. Lipid panel		80061		$	$	$	$	$
			ee. Mammogram (as indicated)		77057		$	$	$	$	$
			ff. Mantoux skin test & interruptation		86580		$	$	$	$	$
			gg. Prostate specific antigen (PSA)		84153		$	$	$	$	$
			hh. Pulmonary function test		94010		$	$	$	$	$
			ii. RBC Cholinesterase x 1 draw		82482		$	$	$	$	$
			jj. Serology, RPR		86592		$	$	$	$	$
			kk. Sickle Cell-Mediterranean or Black only		85660		$	$	$	$	$
			ll. Stool for occult blood x's 3		82270		$	$	$	$	$
			mm. Stool for Ova & Parasites (as indicated)		87177		$	$	$	$	$
			nn. Tdap: Tetanus/diphtheria/pertussis every 10 yrs		90715		$	$	$	$	$
			ool. Tetanus/ diphtheria every 10 years or Tdap		90718		$	$	$	$	$
			pp. Tuberculin test & interpretation by medical prof		86580		$	$	$	$	$
			qq. UA and micro.		81001		$	$	$	$	$
			rr. Visual fields Strabismus, Color Vision		99172		$	$	$	$	$
14.		Hourly Rate for Expert Testimony			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
						99075	$	$	$	$	$
15.		Hourly Rate for Medical Consultation and Training					$	$	$	$	$
						99078
*		Total Pricing Per Year					$	$	$	$	$
**		Grand Total (all years)					$	$	$	$	$
		(Vitals include: ht, wt, B/P, pulse, respiration, temperature)

Los Angeles

				Request for Proposal (RFP) - Pricing matrix
SECTION A						Date: 2/08
Los Angeles
Vendor Name
POC Name				Phone Number
	Below is the estimate of the number of each exam per category per year
1.	Fitness-for-Duty Physical Examinations				150
2.	Pre-Employment (Applicant) Physical Examinations				60
3.	Cardiovascular (Stress) Tests				100
4.	FAA Physical Examinations (pilot)				5
5.	Language Specialists requiring Audiometer Testing				20
6.	LEGAT and Dependents Physical Examinations				40
7.	Hazardous Materials Response Unit (HMRU) Examinations				100
8.	Respiratory Clearance Examinations				100
9.	Hazardous Device School				100
10.	Department of Transportation (DOT) Physical Examinations (drivers)				5
11.	FBI Dive Examimations - Navy Dive Standards				5
SECTION B
1.		Fitness-for-Duty Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for performing one of this exam type refer to FD 943, section J
						$	$	$	$	$
2.		Pre-Employment Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for performing this exam, Refer to FD 945
						$	$	$	$	$
3.		Cardiovascular (Stress) Tests				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each test listed below
	Special Studies		a. Treadmill Bruce protocol			$	$	$	$	$
			b. Thallium SPECT Stress			$	$	$	$	$
			c. Echocardiogram, Stress			$	$	$	$	$
4.		FAA Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	(Must be conducted by certified FAA examiner)

Components are listed on FAA forms, see FD 963, section J

			FAA Class 1				$	$	$	$	$
			Class 2 Medical Certificate
5.		Language Specialists requiring Audiometer Testing					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Audiometer Testing						$	$	$	$	$
6.		LEGAT and Dependents Physical					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter total price for perfroming exam, Refer to FD 949, 50, 51, section J						$	$	$	$	$
7.		Hazardous Materials Response Unit (HMRU) Exam					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each component listed below, Refer to FD 944, 947						$	$	$	$	$
8.		Respiratory Clearance Exam					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 946, (support only, no agents)						$	$	$	$	$
9.		Hazardous Device School					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 965, Section J						$	$	$	$	$
10.		Department of Transportation (DOT) Physical					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 964, Section J						$	$	$	$	$
11.		FBI Dive Examinations - NAVY Dive Standards					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to , List of Attachments, FD 966, Section J						$	$	$	$	$
	Enter Total price per complete exam in colums K-O row 60 above
12.		Immunizations			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each injection listed below (price w & w/o FBI supplied serum)
Standard			a. Polio (IPV)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90713		$	$	$	$	$
			b. MMR booster (born 1957 +)
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90707		$	$	$	$	$
			c. Tetanus/Diptheria booster (every 10 years)
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90718		$	$	$	$	$
			d. Tdap tetanus/Diptheria/Pertussis
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90715		$	$	$	$	$
			e. Hepatitis A (per shot)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90632		$	$	$	$	$
			f. Hepatitis B (per shot)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90746		$	$	$	$	$
			g. Typhoid	i. Oral
				ii. admin w/ FBI serum	90473		$	$	$	$	$
				iii. Admin w/o FBI serum	90473/90690		$	$	$	$	$
			h. Typhoid	i. IM (every 2 yrs)
				ii. Admin w/FBI serum	90471		$	$	$	$	$
				iii. admin w/o FBI serum	90471/90691		$	$	$	$	$
			i. Influenza	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90658		$	$	$	$	$
Special Use			a. Meningococcal Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471 &		$	$	$	$	$
					90733 or 90734		$	$	$	$	$
			b. Yellow Fever	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90717		$	$	$	$	$
			c. Rabies Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			d. Japanese B Encephalitis	i. w/FBI supplied serum	90471		$	$	$	$	$
			d. Anthrax Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			e. Botulinum Toxin Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			f. Twinvax	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90636		$	$	$	$	$
Enter unit price of each immunization listed below
Malaria				i. Malarone
				* admin w/o FBI supplying	4120F		$	$	$	$	$
				ii. Doxycycline
				* admin w/o FBI supplying	4120F		$	$	$	$	$
				iii. Mefloquine
				* admin w/o FBI supplying	4120F		$	$	$	$	$
13.		Additional Individual Testing as Requested			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
			a. ALT		84460		$	$	$	$	$
			b. Audiometry		92551		$	$	$	$	$
			c. Blood group and type		86900, 01		$	$	$	$	$
			d. Blood Lead-age 9 mos. through 6 years		83655		$	$	$	$	$
			e. Blood renal and metabolic panels		80053		$	$	$	$	$
			f. Cardiologist over read of EKG		99499		$	$	$	$	$
			g. Chest X-ray, PA/LAT		71020		$	$	$	$	$
			h. Chest x-ray over read by radiologist		76499		$	$	$	$	$
			i. Colonoscopy - per approval		45378		$	$	$	$	$
			j. Complete blood count with diff		85025		$	$	$	$	$
			k. Complete GYN Exam w/ PAP as indicated		88141		$	$	$	$	$
			li. Completion of Respiratory Questionnaire		FD-900		$	$	$	$	$
			m. Creatinine		82565		$	$	$	$	$
			n. CXR - P/A and lateral		71020		$	$	$	$	$
			o. Digital Rectal Exam, Male > 40- offer		45999		$	$	$	$	$
			p. Distant and Near Visual Acuity, w & w/o correction		99172		$	$	$	$	$
			q. Electrocardiogram w/interpretation		93000		$	$	$	$	$
			r. Fasting Blood Glucose		82947		$	$	$	$	$
			s. Flexible Sigmoidoscopy - per approval		45330		$	$	$	$	$
			q. G6PD, if not previously done		82955		$	$	$	$	$
			r. GGT & Uric Acid		82977/84550		$	$	$	$	$	a. Urinalysis	81001
			t. HbA1C		83036		$	$	$	$	$	b. Stool for occult blood X 3 - offer	82270
			v. Hepatitis B Antibody and Antigen		87340/86706		$	$	$	$	$
			w. Hepatitis C antibody		86803		$	$	$	$	$
			x. History, physical exam, vitals, written summary		99395,96,97		$	$	$	$	$
			y. HIV, I & II Elisa		87390/87391		$	$	$	$	$
			z. IGRA as alternative to tubercullin skin tests				$	$	$	$	$
			aa. Influenza, annually		90658		$	$	$	$	$
			bb. Intraocular Tension (IOT) > 40 years of age		92120		$	$	$	$	$
			cc. Lead & ZPP (if authorized by HCPU)		84202/83655		$	$	$	$	$
			dd. Lipid panel		80061		$	$	$	$	$
			ee. Mammogram (as indicated)		77057		$	$	$	$	$
			ff. Mantoux skin test & interruptation		86580		$	$	$	$	$
			gg. Prostate specific antigen (PSA)		84153		$	$	$	$	$
			hh. Pulmonary function test		94010		$	$	$	$	$
			ii. RBC Cholinesterase x 1 draw		82482		$	$	$	$	$
			jj. Serology, RPR		86592		$	$	$	$	$
			kk. Sickle Cell-Mediterranean or Black only		85660		$	$	$	$	$
			ll. Stool for occult blood x's 3		82270		$	$	$	$	$
			mm. Stool for Ova & Parasites (as indicated)		87177		$	$	$	$	$
			nn. Tdap: Tetanus/diphtheria/pertussis every 10 yrs		90715		$	$	$	$	$
			ool. Tetanus/ diphtheria every 10 years or Tdap		90718		$	$	$	$	$
			pp. Tuberculin test & interpretation by medical prof		86580		$	$	$	$	$
			qq. UA and micro.		81001		$	$	$	$	$
			rr. Visual fields Strabismus, Color Vision		99172		$	$	$	$	$
14.		Hourly Rate for Expert Testimony			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
						99075	$	$	$	$	$
15.		Hourly Rate for Medical Consultation and Training					$	$	$	$	$
						99078
*		Total Pricing Per Year					$	$	$	$	$
**		Grand Total (all years)					$	$	$	$	$
		(Vitals include: ht, wt, B/P, pulse, respiration, temperature)

New York

				Request for Proposal (RFP) - Pricing matrix
SECTION A						Date: 2/08
New York
Vendor Name
POC Name				Phone Number
	Below is the estimate of the number of each exam per category per year
1.	Fitness-for-Duty Physical Examinations				600
2.	Pre-Employment (Applicant) Physical Examinations				75
3.	Cardiovascular (Stress) Tests				300
4.	FAA Physical Examinations (pilot)				10
5.	Language Specialists requiring Audiometer Testing				100
6.	LEGAT and Dependents Physical Examinations				15
7.	Hazardous Materials Response Unit (HMRU) Examinations				20
8.	Respiratory Clearance Examinations				70
9.	Hazardous Device School				10
10.	Department of Transportation (DOT) Physical Examinations (drivers)				10
11.	FBI Dive Examimations - Navy Dive Standards				15
SECTION B
1.		Fitness-for-Duty Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for performing one of this exam type refer to FD 943, section J
						$	$	$	$	$
2.		Pre-Employment Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for performing this exam, Refer to FD 945
						$	$	$	$	$
3.		Cardiovascular (Stress) Tests				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each test listed below
	Special Studies		a. Treadmill Bruce protocol			$	$	$	$	$
			b. Thallium SPECT Stress			$	$	$	$	$
			c. Echocardiogram, Stress			$	$	$	$	$
4.		FAA Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	(Must be conducted by certified FAA examiner)

Components are listed on FAA forms, see FD 963, section J

			FAA Class 1				$	$	$	$	$
			Class 2 Medical Certificate
5.		Language Specialists requiring Audiometer Testing					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Audiometer Testing						$	$	$	$	$
6.		LEGAT and Dependents Physical					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter total price for perfroming exam, Refer to FD 949, 50, 51, section J						$	$	$	$	$
7.		Hazardous Materials Response Unit (HMRU) Exam					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each component listed below, Refer to FD 944, 947						$	$	$	$	$
8.		Respiratory Clearance Exam					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 946, (support only, no agents)						$	$	$	$	$
9.		Hazardous Device School					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 965, Section J						$	$	$	$	$
10.		Department of Transportation (DOT) Physical					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 964, Section J						$	$	$	$	$
11.		FBI Dive Examinations - NAVY Dive Standards					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to , List of Attachments, FD 966, Section J						$	$	$	$	$
	Enter Total price per complete exam in colums K-O row 60 above
12.		Immunizations			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
Enter unit price for each injection listed below (price w & w/o FBI supplied serum)
Standard			a. Polio (IPV)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90713		$	$	$	$	$
			b. MMR booster (born 1957 +)
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90707		$	$	$	$	$
			c. Tetanus/Diptheria booster (every 10 years)
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90718		$	$	$	$	$
			d. Tdap tetanus/Diptheria/Pertussis
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90715		$	$	$	$	$
			e. Hepatitis A (per shot)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90632		$	$	$	$	$
			f. Hepatitis B (per shot)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90746		$	$	$	$	$
			g. Typhoid	i. Oral
				ii. admin w/ FBI serum	90473		$	$	$	$	$
				iii. Admin w/o FBI serum	90473/90690		$	$	$	$	$
			h. Typhoid	i. IM (every 2 yrs)
				ii. Admin w/FBI serum	90471		$	$	$	$	$
				iii. admin w/o FBI serum	90471/90691		$	$	$	$	$
			i. Influenza	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90658		$	$	$	$	$
Special Use			a. Meningococcal Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471 &		$	$	$	$	$
					90733 or 90734		$	$	$	$	$
			b. Yellow Fever	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90717		$	$	$	$	$
			c. Rabies Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			d. Japanese B Encephalitis	i. w/FBI supplied serum	90471		$	$	$	$	$
			d. Anthrax Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			e. Botulinum Toxin Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			f. Twinvax	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90636		$	$	$	$	$
Enter unit price of each immunization listed below
Malaria				i. Malarone
				* admin w/o FBI supplying	4120F		$	$	$	$	$
				ii. Doxycycline
				* admin w/o FBI supplying	4120F		$	$	$	$	$
				iii. Mefloquine
				* admin w/o FBI supplying	4120F		$	$	$	$	$
13.		Additional Individual Testing as Requested			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
			a. ALT		84460		$	$	$	$	$
			b. Audiometry		92551		$	$	$	$	$
			c. Blood group and type		86900, 01		$	$	$	$	$
			d. Blood Lead-age 9 mos. through 6 years		83655		$	$	$	$	$
			e. Blood renal and metabolic panels		80053		$	$	$	$	$
			f. Cardiologist over read of EKG		99499		$	$	$	$	$
			g. Chest X-ray, PA/LAT		71020		$	$	$	$	$
			h. Chest x-ray over read by radiologist		76499		$	$	$	$	$
			i. Colonoscopy - per approval		45378		$	$	$	$	$
			j. Complete blood count with diff		85025		$	$	$	$	$
			k. Complete GYN Exam w/ PAP as indicated		88141		$	$	$	$	$
			li. Completion of Respiratory Questionnaire		FD-900		$	$	$	$	$
			m. Creatinine		82565		$	$	$	$	$
			n. CXR - P/A and lateral		71020		$	$	$	$	$
			o. Digital Rectal Exam, Male > 40- offer		45999		$	$	$	$	$
			p. Distant and Near Visual Acuity, w & w/o correction		99172		$	$	$	$	$
			q. Electrocardiogram w/interpretation		93000		$	$	$	$	$
			r. Fasting Blood Glucose		82947		$	$	$	$	$
			s. Flexible Sigmoidoscopy - per approval		45330		$	$	$	$	$
			q. G6PD, if not previously done		82955		$	$	$	$	$
			r. GGT & Uric Acid		82977/84550		$	$	$	$	$	a. Urinalysis	81001
			t. HbA1C		83036		$	$	$	$	$	b. Stool for occult blood X 3 - offer	82270
			v. Hepatitis B Antibody and Antigen		87340/86706		$	$	$	$	$
			w. Hepatitis C antibody		86803		$	$	$	$	$
			x. History, physical exam, vitals, written summary		99395,96,97		$	$	$	$	$
			y. HIV, I & II Elisa		87390/87391		$	$	$	$	$
			z. IGRA as alternative to tubercullin skin tests				$	$	$	$	$
			aa. Influenza, annually		90658		$	$	$	$	$
			bb. Intraocular Tension (IOT) > 40 years of age		92120		$	$	$	$	$
			cc. Lead & ZPP (if authorized by HCPU)		84202/83655		$	$	$	$	$
			dd. Lipid panel		80061		$	$	$	$	$
			ee. Mammogram (as indicated)		77057		$	$	$	$	$
			ff. Mantoux skin test & interruptation		86580		$	$	$	$	$
			gg. Prostate specific antigen (PSA)		84153		$	$	$	$	$
			hh. Pulmonary function test		94010		$	$	$	$	$
			ii. RBC Cholinesterase x 1 draw		82482		$	$	$	$	$
			jj. Serology, RPR		86592		$	$	$	$	$
			kk. Sickle Cell-Mediterranean or Black only		85660		$	$	$	$	$
			ll. Stool for occult blood x's 3		82270		$	$	$	$	$
			mm. Stool for Ova & Parasites (as indicated)		87177		$	$	$	$	$
			nn. Tdap: Tetanus/diphtheria/pertussis every 10 yrs		90715		$	$	$	$	$
			ool. Tetanus/ diphtheria every 10 years or Tdap		90718		$	$	$	$	$
			pp. Tuberculin test & interpretation by medical prof		86580		$	$	$	$	$
			qq. UA and micro.		81001		$	$	$	$	$
			rr. Visual fields Strabismus, Color Vision		99172		$	$	$	$	$
14.		Hourly Rate for Expert Testimony			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
						99075	$	$	$	$	$
15.		Hourly Rate for Medical Consultation and Training					$	$	$	$	$
						99078
*		Total Pricing Per Year					$	$	$	$	$
**		Grand Total (all years)					$	$	$	$	$
		(Vitals include: ht, wt, B/P, pulse, respiration, temperature)

Houston

				Request for Proposal (RFP) - Pricing matrix
SECTION A						Date: 2/08
Houston
Vendor Name
POC Name				Phone Number
	Below is the estimate of the number of each exam per category per year
1.	Fitness-for-Duty Physical Examinations				235
2.	Pre-Employment (Applicant) Physical Examinations				45
3.	Cardiovascular (Stress) Tests				55
4.	FAA Physical Examinations (pilot)				15
5.	Language Specialists requiring Audiometer Testing				25
6.	LEGAT and Dependents Physical Examinations				15
7.	Hazardous Materials Response Unit (HMRU) Examinations				6
8.	Respiratory Clearance Examinations				25
9.	Hazardous Device School				5
10.	Department of Transportation (DOT) Physical Examinations (drivers)				1
11.	FBI Dive Examimations - Navy Dive Standards				0
SECTION B
1.		Fitness-for-Duty Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for performing one of this exam type refer to FD 943, section J
						$	$	$	$	$
2.		Pre-Employment Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for performing this exam, Refer to FD 945
						$	$	$	$	$
3.		Cardiovascular (Stress) Tests				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each test listed below
	Special Studies		a. Treadmill Bruce protocol			$	$	$	$	$
			b. Thallium SPECT Stress			$	$	$	$	$
			c. Echocardiogram, Stress			$	$	$	$	$
4.		FAA Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	(Must be conducted by certified FAA examiner)

Components are listed on FAA forms, see FD 963, section J

			FAA Class 1				$	$	$	$	$
			Class 2 Medical Certificate
5.		Language Specialists requiring Audiometer Testing					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Audiometer Testing						$	$	$	$	$
6.		LEGAT and Dependents Physical					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter total price for perfroming exam, Refer to FD 949, 50, 51, section J						$	$	$	$	$
7.		Hazardous Materials Response Unit (HMRU) Exam					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each component listed below, Refer to FD 944, 947						$	$	$	$	$
8.		Respiratory Clearance Exam					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 946, (support only, no agents)						$	$	$	$	$
9.		Hazardous Device School					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 965, Section J						$	$	$	$	$
10.		Department of Transportation (DOT) Physical					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 964, Section J						$	$	$	$	$
11.		FBI Dive Examinations - NAVY Dive Standards					Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to , List of Attachments, FD 966, Section J						$	$	$	$	$
	Enter Total price per complete exam in colums K-O row 60 above
12.		Immunizations			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
Enter unit price for each injection listed below (price w & w/o FBI supplied serum)
Standard			a. Polio (IPV)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90713		$	$	$	$	$
			b. MMR booster (born 1957 +)
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90707		$	$	$	$	$
			c. Tetanus/Diptheria booster (every 10 years)
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90718		$	$	$	$	$
			d. Tdap tetanus/Diptheria/Pertussis
				i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90715		$	$	$	$	$
			e. Hepatitis A (per shot)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90632		$	$	$	$	$
			f. Hepatitis B (per shot)	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90746		$	$	$	$	$
			g. Typhoid	i. Oral
				ii. admin w/ FBI serum	90473		$	$	$	$	$
				iii. Admin w/o FBI serum	90473/90690		$	$	$	$	$
			h. Typhoid	i. IM (every 2 yrs)
				ii. Admin w/FBI serum	90471		$	$	$	$	$
				iii. admin w/o FBI serum	90471/90691		$	$	$	$	$
			i. Influenza	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90658		$	$	$	$	$
Special Use			a. Meningococcal Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471 &		$	$	$	$	$
					90733 or 90734		$	$	$	$	$
			b. Yellow Fever	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90717		$	$	$	$	$
			c. Rabies Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			d. Japanese B Encephalitis	i. w/FBI supplied serum	90471		$	$	$	$	$
			d. Anthrax Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			e. Botulinum Toxin Vaccine	i. w/FBI supplied serum	90471		$	$	$	$	$
			f. Twinvax	i. w/FBI supplied serum	90471		$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90636		$	$	$	$	$
Enter unit price of each immunization listed below
Malaria				i. Malarone
				* admin w/o FBI supplying	4120F		$	$	$	$	$
				ii. Doxycycline
				* admin w/o FBI supplying	4120F		$	$	$	$	$
				iii. Mefloquine
				* admin w/o FBI supplying	4120F		$	$	$	$	$
13.		Additional Individual Testing as Requested			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
			a. ALT		84460		$	$	$	$	$
			b. Audiometry		92551		$	$	$	$	$
			c. Blood group and type		86900, 01		$	$	$	$	$
			d. Blood Lead-age 9 mos. through 6 years		83655		$	$	$	$	$
			e. Blood renal and metabolic panels		80053		$	$	$	$	$
			f. Cardiologist over read of EKG		99499		$	$	$	$	$
			g. Chest X-ray, PA/LAT		71020		$	$	$	$	$
			h. Chest x-ray over read by radiologist		76499		$	$	$	$	$
			i. Colonoscopy - per approval		45378		$	$	$	$	$
			j. Complete blood count with diff		85025		$	$	$	$	$
			k. Complete GYN Exam w/ PAP as indicated		88141		$	$	$	$	$
			li. Completion of Respiratory Questionnaire		FD-900		$	$	$	$	$
			m. Creatinine		82565		$	$	$	$	$
			n. CXR - P/A and lateral		71020		$	$	$	$	$
			o. Digital Rectal Exam, Male > 40- offer		45999		$	$	$	$	$
			p. Distant and Near Visual Acuity, w & w/o correction		99172		$	$	$	$	$	a. Urinalysis	81001
			q. Electrocardiogram w/interpretation		93000		$	$	$	$	$	b. Stool for occult blood X 3 - offer	82270
			r. Fasting Blood Glucose		82947		$	$	$	$	$
			s. Flexible Sigmoidoscopy - per approval		45330		$	$	$	$	$
			q. G6PD, if not previously done		82955		$	$	$	$	$
			r. GGT & Uric Acid		82977/84550		$	$	$	$	$
			t. HbA1C		83036		$	$	$	$	$
			v. Hepatitis B Antibody and Antigen		87340/86706		$	$	$	$	$
			w. Hepatitis C antibody		86803		$	$	$	$	$
			x. History, physical exam, vitals, written summary		99395,96,97		$	$	$	$	$
			y. HIV, I & II Elisa		87390/87391		$	$	$	$	$
			z. IGRA as alternative to tubercullin skin tests				$	$	$	$	$
			aa. Influenza, annually		90658		$	$	$	$	$
			bb. Intraocular Tension (IOT) > 40 years of age		92120		$	$	$	$	$
			cc. Lead & ZPP (if authorized by HCPU)		84202/83655		$	$	$	$	$
			dd. Lipid panel		80061		$	$	$	$	$
			ee. Mammogram (as indicated)		77057		$	$	$	$	$
			ff. Mantoux skin test & interruptation		86580		$	$	$	$	$
			gg. Prostate specific antigen (PSA)		84153		$	$	$	$	$
			hh. Pulmonary function test		94010		$	$	$	$	$
			ii. RBC Cholinesterase x 1 draw		82482		$	$	$	$	$
			jj. Serology, RPR		86592		$	$	$	$	$
			kk. Sickle Cell-Mediterranean or Black only		85660		$	$	$	$	$
			ll. Stool for occult blood x's 3		82270		$	$	$	$	$
			mm. Stool for Ova & Parasites (as indicated)		87177		$	$	$	$	$
			nn. Tdap: Tetanus/diphtheria/pertussis every 10 yrs		90715		$	$	$	$	$
			ool. Tetanus/ diphtheria every 10 years or Tdap		90718		$	$	$	$	$
			pp. Tuberculin test & interpretation by medical prof		86580		$	$	$	$	$
			qq. UA and micro.		81001		$	$	$	$	$
			rr. Visual fields Strabismus, Color Vision		99172		$	$	$	$	$
14.		Hourly Rate for Expert Testimony			CPT Code		Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
						99075	$	$	$	$	$
15.		Hourly Rate for Medical Consultation and Training					$	$	$	$	$
						99078
*		Total Pricing Per Year					$	$	$	$	$
**		Grand Total (all years)					$	$	$	$	$
		(Vitals include: ht, wt, B/P, pulse, respiration, temperature)

Portland, ME

				Request for Proposal (RFP) - Pricing matrix
SECTION A					Date: 2/08
Portland, ME
Vendor Name
POC Name				Phone Number
Below is the estimate of the number of each exam per category per year (See Boston)
1.	Fitness-for-Duty Physical Examinations
2.	Pre-Employment (Applicant) Physical Examinations
3.	Cardiovascular (Stress) Tests
4.	FAA Physical Examinations (pilot)
5.	Language Specialists requiring Audiometer Testing
6.	LEGAT and Dependents Physical Examinations
7.	Hazardous Materials Response Unit (HMRU) Examinations
8.	Respiratory Clearance Examinations
9.	Hazardous Device School
10.	Department of Transportation (DOT) Physical Examinations (drivers)
11.	FBI Dive Examimations - Navy Dive Standards
SECTION B
1.		Fitness-for-Duty Physical			Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for performing one of this exam type refer to FD 943, section J
					$	$	$	$	$
2.		Pre-Employment Physical			Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for performing this exam, Refer to FD 945
					$	$	$	$	$
3.		Cardiovascular (Stress) Tests			Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each test listed below
	Special Studies		a. Treadmill Bruce protocol		$	$	$	$	$
			b. Thallium SPECT Stress		$	$	$	$	$
			c. Echocardiogram, Stress		$	$	$	$	$
4.		FAA Physical			Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	(Must be conducted by certified FAA examiner)

Components are listed on FAA forms, see FD 963, section J

			FAA Class 1			$	$	$	$	$
			Class 2 Medical Certificate
5.		Language Specialists requiring Audiometer Testing				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Audiometer Testing					$	$	$	$	$
6.		LEGAT and Dependents Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter total price for perfroming exam, Refer to FD 949, 50, 51, section J					$	$	$	$	$
7.		Hazardous Materials Response Unit (HMRU) Exam				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Enter unit price for each component listed below, Refer to FD 944, 947					$	$	$	$	$
8.		Respiratory Clearance Exam				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 946, (support only, no agents)					$	$	$	$	$
9.		Hazardous Device School				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 965, Section J					$	$	$	$	$
10.		Department of Transportation (DOT) Physical				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to - List of Attachments, FD 964, Section J					$	$	$	$	$
11.		FBI Dive Examinations - NAVY Dive Standards				Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
	Refer to , List of Attachments, FD 966, Section J					$	$	$	$	$
	Enter Total price per complete exam in colums K-O row 60 above
12.		Immunizations			CPT Code	Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
Enter unit price for each injection listed below (price w & w/o FBI supplied serum)
Standard			a. Polio (IPV)	i. w/FBI supplied serum	90471	$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90713	$	$	$	$	$
			b. MMR booster (born 1957 +)
				i. w/FBI supplied serum	90471	$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90707	$	$	$	$	$
			c. Tetanus/Diptheria booster (every 10 years)
				i. w/FBI supplied serum	90471	$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90718	$	$	$	$	$
			d. Tdap tetanus/Diptheria/Pertussis
				i. w/FBI supplied serum	90471	$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90715	$	$	$	$	$
			e. Hepatitis A (per shot)	i. w/FBI supplied serum	90471	$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90632	$	$	$	$	$
			f. Hepatitis B (per shot)	i. w/FBI supplied serum	90471	$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90746	$	$	$	$	$
			g. Typhoid	i. Oral
				ii. admin w/ FBI serum	90473	$	$	$	$	$
				iii. Admin w/o FBI serum	90473/90690	$	$	$	$	$
			h. Typhoid	i. IM (every 2 yrs)
				ii. Admin w/FBI serum	90471	$	$	$	$	$
				iii. admin w/o FBI serum	90471/90691	$	$	$	$	$
			i. Influenza	i. w/FBI supplied serum	90471	$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90658	$	$	$	$	$
Special Use			a. Meningococcal Vaccine	i. w/FBI supplied serum	90471	$	$	$	$	$
				ii. w/o FBI supplied serum	90471 &	$	$	$	$	$
					90733 or 90734	$	$	$	$	$
			b. Yellow Fever	i. w/FBI supplied serum	90471	$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90717	$	$	$	$	$
			c. Rabies Vaccine	i. w/FBI supplied serum	90471	$	$	$	$	$
			d. Japanese B Encephalitis	i. w/FBI supplied serum	90471	$	$	$	$	$
			d. Anthrax Vaccine	i. w/FBI supplied serum	90471	$	$	$	$	$
			e. Botulinum Toxin Vaccine	i. w/FBI supplied serum	90471	$	$	$	$	$
			f. Twinvax	i. w/FBI supplied serum	90471	$	$	$	$	$
				ii. w/o FBI supplied serum	90471/90636	$	$	$	$	$
Enter unit price of each immunization listed below
Malaria				i. Malarone
				* admin w/o FBI supplying	4120F	$	$	$	$	$
				ii. Doxycycline
				* admin w/o FBI supplying	4120F	$	$	$	$	$
				iii. Mefloquine
				* admin w/o FBI supplying	4120F	$	$	$	$	$
13.		Additional Individual Testing as Requested			CPT Code	Base Year	Option Yr 1	Option Yr 2	Option Yr 3	Option Yr 4
			a. ALT		84460	$	$	$	$	$
			b. Audiometry		92551	$	$	$	$	$
			c. Blood group and type		86900, 01	$	$	$	$	$
			d. Blood Lead-age 9 mos. through 6 years		83655	$	$	$	$	$
			e. Blood renal and metabolic panels		80053	$	$	$	$	$
			f. Cardiologist over read of EKG		99499	$	$	$	$	$
			g. Chest X-ray, PA/LAT		71020	$	$	$	$	$
			h. Chest x-ray over read by radiologist		76499	$	$	$	$	$
			i. Colonoscopy - per approval		45378	$	$	$	$	$
			j. Complete blood count with diff		85025	$	$	$	$	$
			k. Complete GYN Exam w/ PAP as indicated		88141	$	$	$	$	$
			li. Completion of Respiratory Questionnaire		FD-900	$	$	$	$	$
			m. Creatinine		82565	$	$	$	$	$
			n. CXR - P/A and lateral		71020	$	$	$	$	$
			o. Digital Rectal Exam, Male > 40- offer		45999	$	$	$	$	$
			p. Distant and Near Visual Acuity, w & w/o correction		99172	$	$	$	$	$	a. Urinalysis	81001
			q. Electrocardiogram w/interpretation		93000	$	$	$	$	$	b. Stool for occult blood X 3 - offer	82270
			r. Fasting Blood Glucose		82947	$	$	$	$	$
			s. Flexible Sigmoidoscopy - per approval		45330	$	$	$	$	$
			q. G6PD, if not previously done		82955	$	$	$	$	$
			r. GGT & Uric Acid		82977/84550	$	$	$	$	$
			t. HbA1C		83036	$	$	$	$	$
			v. Hepatitis B Antibody and Antigen		87340/86706	$	$	$	$	$
			w. Hepatitis C antibody		86803	$	$	$	$	$
			x. History, physical exam, vitals, written summary		99395,96,97	$	$	$	$	$
			y. HIV, I & II Elisa		87390/87391	$	$	$	$	$
			z. IGRA as alternative to tubercullin skin tests			$	$	$	$	$
			aa. Influenza, annually		90658	$	$	$	$	$
			bb. Intraocular Tension (IOT) > 40 years of age		92120	$	$	$	$	$
			cc. Lead & ZPP (if authorized by HCPU)		84202/83655	$	$	$	$	$
			dd. Lipid panel		80061	$	$	$	$	$
			ee. Mammogram (as indicated)		77057	$	$	$	$	$
			ff. Mantoux skin test & interruptation		86580	$	$	$	$	$
			gg. Prostate specific antigen (PSA)		84153	$	$	$	$	$

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Nov 14, 2017.