Attachment 8 - Pricing Template_Amend 0003.XLS
XLS spreadsheet 289 KB Posted
- Solicitation number
- Solicitation_HQ0034-20-R-0211
- Issued by
-
DOD Washington Headquarters Service
About this file
This document contains a pricing template for an indefinite delivery, indefinite quantity contract for occupational health and medical case review services. The template outlines pricing for services such as medical examinations, laboratory tests, radiology exams, and specialty consultations across multiple contract line items and ordering periods. Pricing is provided for five one-year ordering periods as well as a six-month extension option. The total potential contract value including all ordering periods and the extension is $101.2 million. Relevant federal agencies include the DoD Washington Headquarters Service.
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Tab 1 - Price Schedule Summary
| Phase-in Labor | Contract Type | CLIN # | Rate | Hours | Total Price |
| Services | Time & Material | 0006 | |||
| Labor | FFP | 0007 | |||
| TOTALS | $ - 0 |
| IDIQ CEILING (Year 1 Schedule Pricing) | CLIN # | Rate | Hours | Total Price | |
| Occupational Health Services & Independent Medical Examinations | Time & Material | 0001 | $10,950,000.00 | ||
| Medical & Independent Case Reviews | Time & Material | 0002 | $7,300,000.00 | ||
| Travel | Time & Material | 0003 | $50,000.00 | ||
| Other Direct Costs | Time & Material | 0004 | $100,000.00 | ||
| Program Management Support Services | FFP | 0005 | |||
| TOTALS | $18,400,000.00 |
| IDIQ CEILING (Year 2 Schedule Pricing) | CLIN # | Rate | Hours | Total Price | |
| Occupational Health Services & Independent Medical Examinations | Time & Material | 1001 | $ 10,950,000.00 | ||
| Medical & Independent Case Reviews | Time & Material | 1002 | $ 7,300,000.00 | ||
| Travel | Time & Material | 1003 | $50,000.00 | ||
| Other Direct Costs | Time & Material | 1004 | $100,000.00 | ||
| Program Management Support Services | FFP | 1005 | |||
| TOTALS | $ 18,400,000.00 |
| IDIQ CEILING (Year 3 Schedule Pricing) | CLIN # | Rate | Hours | Total Price | |
| Occupational Health Services & Independent Medical Examinations | Time & Material | 2001 | $ 10,950,000.00 | ||
| Medical & Independent Case Reviews | Time & Material | 2002 | $ 7,300,000.00 | ||
| Travel | Time & Material | 2003 | $50,000.00 | ||
| Other Direct Costs | Time & Material | 2004 | $100,000.00 | ||
| Program Management Support Services | FFP | 2005 | |||
| TOTALS | $ 18,400,000.00 |
| IDIQ CEILING (Year 4 Schedule Pricing) | CLIN # | Rate | Hours | Total Price | |
| Occupational Health Services & Independent Medical Examinations | Time & Material | 3001 | $ 10,950,000.00 | ||
| Medical & Independent Case Reviews | Time & Material | 3002 | $ 7,300,000.00 | ||
| Travel | Time & Material | 3003 | $50,000.00 | ||
| Other Direct Costs | Time & Material | 3004 | $100,000.00 | ||
| Program Management Support Services | FFP | 3005 | |||
| TOTALS | $ 18,400,000.00 |
| IDIQ CEILING (Year 5 Schedule Pricing) | CLIN # | Rate | Hours | Total Price | |
| Occupational Health Services & Independent Medical Examinations | Time & Material | 4001 | $ 10,950,000.00 | ||
| Medical & Independent Case Reviews | Time & Material | 4003 | $ 7,300,000.00 | ||
| Travel | Time & Material | 4003 | $50,000.00 | ||
| Other Direct Costs | Time & Material | 4004 | $100,000.00 | ||
| Program Management Support Services | FFP | 4005 | |||
| TOTALS | $ 18,400,000.00 |
| IDIQ Phase-in Ceiling Price | IDIQ Year 1 Ceiling Price | IDIQ Year 2 Ceiling Price | IDIQ Year 3 Ceiling Price | IDIQ Year 4 Ceiling Price | IDIQ Year 5 Ceiling Price | TOTAL PRICE | FAR 52.217-8 (6 MONTH EXTENSION) TOTAL PRICE | TOTAL PRICE (EACH YEAR CEILING PRICE + DASH 8 EXT.) |
| $ - 0 | $18,400,000.00 | $ 18,400,000.00 | $ 18,400,000.00 | $ 18,400,000.00 | $ 18,400,000.00 | $ 92,000,000.00 | $ 9,200,000.00 | $ 101,200,000.00 |
***Do not input data in the grayed out area***
Tab 2 - Time & Material Year 1 Price Per Service - Year 1 Schedule Pricing Price Per Service - Year 1 Schedule Pricing Price Per Service - Year 1 Schedule Pricing Price Per Service - Year 1 Schedule Pricing
| CLIN 0001: Service Type | Alabama | Alaska | Arizona | California | Colorado | Connecticut | Delaware | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | ||||||||||||||||||||||||||||||||
| High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price |
| Audiometry (Stand Alone) | |
| Audiometry (w/Exam) | |
| Audiometry with CAOHC-Certified Technician (Add-on) | |
| Best Vision Screening (Stand Alone) | |
| Best Vision Screening (w/Exam) | |
| B-Reading | ` |
| Color Doppler | |
| Comprehensive Eye Exam | |
| Comprehensive Vision Screening (Stand Alone) | |
| Comprehensive Vision Screening (w/Exam) | |
| CT Chest (w/Contrast) | |
| CT Chest (w/out Contrast) | |
| Echocardiography | |
| EKG Overread | |
| Electrocardiogram (EKG) | |
| Examination - Brief | |
| Examination - Intermediate | |
| Examination - Comprehensive (Moderate Complexity) | |
| Examination - Comprehensive (High Complexity) | |
| Exercise Stress Test (EST) | |
| Exercise Stress Test (EST) - Thallium/Cardiolyte | |
| Immunization Administration (Injection) - Government Provided Vaccine | |
| Immunization Administration (Intranasal/Oral) - Government Provided Vaccine | |
| Independent Medical Review (up to 1/2 inch or 125 pages) | |
| Respirator Fit Test | |
| Respirator Medical Clearance (Stand Alone) | |
| Respirator Medical Clearance (w/Exam) | |
| Reviewing Medical Officer | |
| Spirometry (Stand Alone) | |
| Spirometry (w/Exam) | |
| Stress Echocardiogram | |
| Tuberculosis Skin Test and Reading (Stand Alone) | |
| Tuberculosis Skin Test and Reading (w/Exam) | |
| Vital Signs/Body Height and Weight (Stand Alone) | |
| Wellness Screening | |
| Wellness Screening - Prostate Cancer with PSA | |
| Wellness Vision Screening | |
| X-Ray - Chest (PA & LAT Views) | |
| X-Ray - Chest (PA View) | |
| Blood Type & Rh (ABO Group & RH Type) | |
| Cardio C-Reactive Protein (Cardio CRP) | |
| CBC (includes Diff/Plt) | |
| Comprehensive Metabolic Profile - NA, K, CL, GLU, BUN, Creat, CA, TP, ALB, Tbili, AP, AST, CO2 | |
| Direct Patient Pay Lipid Panel | |
| Glucose (B) | |
| Glucose 6 Phosphate Dehydrogenase | |
| Glucose, Postprandial/2 Hour | |
| HDL / Cholesterol | |
| Heavy Metals (U): (Arsenic, Mercury Lead, Creatinine) | |
| Heavy Metals (U): (Arsenic, Mercury, Bismuth, Antimony) | |
| Heavy Metals Panel (U): (Arsenic, Mercury, Lead, Cadmium, Creatinine) | |
| Heavy Metals Panel, 24hr (U) (Arsenic, Cadmium, Lead, Mercury) | |
| Heavy Metals Screen (U): (Arsenic, Mercury, Selenium, Bismuth, Tellurium) | |
| HemoglobinA1C | |
| Hep A AB | |
| Hep A IGM | |
| Hep B Core | |
| Hep B Core IGM | |
| Hepatic Function panel (Alb, Tbili, Dbili, AP, AST, ALT) | |
| Hepatitis B Surface Antibody (QL) | |
| Hepatitis B Surface Antibody, Quant. | |
| Hepatitis B surface Antigen | |
| Hepatitis C Virus Antibody | |
| HIV testing (HIV-1 Ab Screen) | |
| LDH | |
| Lead (B) Industrial | |
| Lipid Panel | |
| Liver Function Profile PANEL (AP, ALT, AST, Tbili, Dbili, GGT, LDH, A/G, Ratio) | |
| Measles | |
| Measles, Mumps & Rubella IgG Antibody, Immune Status | |
| Metabolic Profile, Basic (Na, K, Cl, CO2, GLU, BUN, Creat) | |
| Mumps | |
| Reticulocyte Count | |
| Rubella Virus IGG AB By EIA | |
| Sickle Cell Screen | |
| Uric Acid (serum) | |
| Uric Acid (urine) | |
| Urinalysis, Reflex | |
| Varicella Zoster Virus IGG | |
| VISUAL FIELD EXAMINATION | |
| COLOR VISION EXAM | |
| PSYCHOLOGICAL SECURITY CLEARANCE SERVICES TELEHEALTH | |
| CARDIAC RISK PROFILE | |
| DEPTH PERCEPTION | |
| ZPP, Blood Protoporphyrins, zinc | |
| PHORIA | |
| BILIRUBIN, DIRECT | |
| SCREENING TEST OF VISUAL ACUITY | |
| Total |
| CLIN 0002: Service Type | Alabama | Alaska | Arizona | California | Colorado | Connecticut | Delaware | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | ||||||||||||||||||||||||||||||||
| High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price |
| Allergist |
| Audiologist |
| Cardiologist |
| Clarification |
| Dermatologist |
| Endocrinologist |
| Family Practice |
| Gastroenterologist |
| Hematologist |
| Infectious Disease |
| Internist |
| Nephrologist |
| Neurologist |
| Neuropsychiatrist |
| Neurosurgery |
| Oncologist |
| Ophthalmologist |
| Orthopedist |
| Otolaryngologist (E.N.T.) |
| Physical Medicine & Rehabilitation |
| Psychiatrist |
| Psychologist |
| Pulmonologist |
| Rheumatologist |
| Supplemental Request IME |
| Urologist |
| Total |
Tab 3 - Time & Material Year 2 Price Per Service - Year 2 Schedule Pricing Price Per Service - Year 2 Schedule Pricing Price Per Service - Year 2 Schedule Pricing Price Per Service - Year 2 Schedule Pricing
| CLIN 1001: Service Type | Alabama | Alaska | Arizona | California | Colorado | Connecticut | Delaware | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | ||||||||||||||||||||||||||||||||
| High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price |
| Audiometry (Stand Alone) | |
| Audiometry (w/Exam) | |
| Audiometry with CAOHC-Certified Technician (Add-on) | |
| Best Vision Screening (Stand Alone) | |
| Best Vision Screening (w/Exam) | |
| B-Reading | ` |
| Color Doppler | |
| Comprehensive Eye Exam | |
| Comprehensive Vision Screening (Stand Alone) | |
| Comprehensive Vision Screening (w/Exam) | |
| CT Chest (w/Contrast) | |
| CT Chest (w/out Contrast) | |
| Echocardiography | |
| EKG Overread | |
| Electrocardiogram (EKG) | |
| Examination - Brief | |
| Examination - Intermediate | |
| Examination - Comprehensive (Moderate Complexity) | |
| Examination - Comprehensive (High Complexity) | |
| Exercise Stress Test (EST) | |
| Exercise Stress Test (EST) - Thallium/Cardiolyte | |
| Immunization Administration (Injection) - Government Provided Vaccine | |
| Immunization Administration (Intranasal/Oral) - Government Provided Vaccine | |
| Independent Medical Review (up to 1/2 inch or 125 pages) | |
| Respirator Fit Test | |
| Respirator Medical Clearance (Stand Alone) | |
| Respirator Medical Clearance (w/Exam) | |
| Reviewing Medical Officer | |
| Spirometry (Stand Alone) | |
| Spirometry (w/Exam) | |
| Stress Echocardiogram | |
| Tuberculosis Skin Test and Reading (Stand Alone) | |
| Tuberculosis Skin Test and Reading (w/Exam) | |
| Vital Signs/Body Height and Weight (Stand Alone) | |
| Wellness Screening | |
| Wellness Screening - Prostate Cancer with PSA | |
| Wellness Vision Screening | |
| X-Ray - Chest (PA & LAT Views) | |
| X-Ray - Chest (PA View) | |
| Blood Type & Rh (ABO Group & RH Type) | |
| Cardio C-Reactive Protein (Cardio CRP) | |
| CBC (includes Diff/Plt) | |
| Comprehensive Metabolic Profile - NA, K, CL, GLU, BUN, Creat, CA, TP, ALB, Tbili, AP, AST, CO2 | |
| Direct Patient Pay Lipid Panel | |
| Glucose (B) | |
| Glucose 6 Phosphate Dehydrogenase | |
| Glucose, Postprandial/2 Hour | |
| HDL / Cholesterol | |
| Heavy Metals (U): (Arsenic, Mercury Lead, Creatinine) | |
| Heavy Metals (U): (Arsenic, Mercury, Bismuth, Antimony) | |
| Heavy Metals Panel (U): (Arsenic, Mercury, Lead, Cadmium, Creatinine) | |
| Heavy Metals Panel, 24hr (U) (Arsenic, Cadmium, Lead, Mercury) | |
| Heavy Metals Screen (U): (Arsenic, Mercury, Selenium, Bismuth, Tellurium) | |
| HemoglobinA1C | |
| Hep A AB | |
| Hep A IGM | |
| Hep B Core | |
| Hep B Core IGM | |
| Hepatic Function panel (Alb, Tbili, Dbili, AP, AST, ALT) | |
| Hepatitis B Surface Antibody (QL) | |
| Hepatitis B Surface Antibody, Quant. | |
| Hepatitis B surface Antigen | |
| Hepatitis C Virus Antibody | |
| HIV testing (HIV-1 Ab Screen) | |
| LDH | |
| Lead (B) Industrial | |
| Lipid Panel | |
| Liver Function Profile PANEL (AP, ALT, AST, Tbili, Dbili, GGT, LDH, A/G, Ratio) | |
| Measles | |
| Measles, Mumps & Rubella IgG Antibody, Immune Status | |
| Metabolic Profile, Basic (Na, K, Cl, CO2, GLU, BUN, Creat) | |
| Mumps | |
| Reticulocyte Count | |
| Rubella Virus IGG AB By EIA | |
| Sickle Cell Screen | |
| Uric Acid (serum) | |
| Uric Acid (urine) | |
| Urinalysis, Reflex | |
| Varicella Zoster Virus IGG | |
| VISUAL FIELD EXAMINATION | |
| COLOR VISION EXAM | |
| PSYCHOLOGICAL SECURITY CLEARANCE SERVICES TELEHEALTH | |
| CARDIAC RISK PROFILE | |
| DEPTH PERCEPTION | |
| ZPP, Blood Protoporphyrins, zinc | |
| PHORIA | |
| BILIRUBIN, DIRECT | |
| SCREENING TEST OF VISUAL ACUITY | |
| Total |
| CLIN 1002: Service Type | Alabama | Alaska | Arizona | California | Colorado | Connecticut | Delaware | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | ||||||||||||||||||||||||||||||||
| High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price |
| Allergist |
| Audiologist |
| Cardiologist |
| Clarification |
| Dermatologist |
| Endocrinologist |
| Family Practice |
| Gastroenterologist |
| Hematologist |
| Infectious Disease |
| Internist |
| Nephrologist |
| Neurologist |
| Neuropsychiatrist |
| Neurosurgery |
| Oncologist |
| Ophthalmologist |
| Orthopedist |
| Otolaryngologist (E.N.T.) |
| Physical Medicine & Rehabilitation |
| Psychiatrist |
| Psychologist |
| Pulmonologist |
| Rheumatologist |
| Supplemental Request IME |
| Urologist |
| Total |
Tab 4 - Time & Material Year 3 Price Per Service - Year 3 Schedule Pricing Price Per Service - Year 3 Schedule Pricing Price Per Service - Year 3 Schedule Pricing Price Per Service - Year 3 Schedule Pricing
| CLIN 2001: Service Type | Alabama | Alaska | Arizona | California | Colorado | Connecticut | Delaware | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | ||||||||||||||||||||||||||||||||
| High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price |
| Audiometry (Stand Alone) | |
| Audiometry (w/Exam) | |
| Audiometry with CAOHC-Certified Technician (Add-on) | |
| Best Vision Screening (Stand Alone) | |
| Best Vision Screening (w/Exam) | |
| B-Reading | ` |
| Color Doppler | |
| Comprehensive Eye Exam | |
| Comprehensive Vision Screening (Stand Alone) | |
| Comprehensive Vision Screening (w/Exam) | |
| CT Chest (w/Contrast) | |
| CT Chest (w/out Contrast) | |
| Echocardiography | |
| EKG Overread | |
| Electrocardiogram (EKG) | |
| Examination - Brief | |
| Examination - Intermediate | |
| Examination - Comprehensive (Moderate Complexity) | |
| Examination - Comprehensive (High Complexity) | |
| Exercise Stress Test (EST) | |
| Exercise Stress Test (EST) - Thallium/Cardiolyte | |
| Immunization Administration (Injection) - Government Provided Vaccine | |
| Immunization Administration (Intranasal/Oral) - Government Provided Vaccine | |
| Independent Medical Review (up to 1/2 inch or 125 pages) | |
| Respirator Fit Test | |
| Respirator Medical Clearance (Stand Alone) | |
| Respirator Medical Clearance (w/Exam) | |
| Reviewing Medical Officer | |
| Spirometry (Stand Alone) | |
| Spirometry (w/Exam) | |
| Stress Echocardiogram | |
| Tuberculosis Skin Test and Reading (Stand Alone) | |
| Tuberculosis Skin Test and Reading (w/Exam) | |
| Vital Signs/Body Height and Weight (Stand Alone) | |
| Wellness Screening | |
| Wellness Screening - Prostate Cancer with PSA | |
| Wellness Vision Screening | |
| X-Ray - Chest (PA & LAT Views) | |
| X-Ray - Chest (PA View) | |
| Blood Type & Rh (ABO Group & RH Type) | |
| Cardio C-Reactive Protein (Cardio CRP) | |
| CBC (includes Diff/Plt) | |
| Comprehensive Metabolic Profile - NA, K, CL, GLU, BUN, Creat, CA, TP, ALB, Tbili, AP, AST, CO2 | |
| Direct Patient Pay Lipid Panel | |
| Glucose (B) | |
| Glucose 6 Phosphate Dehydrogenase | |
| Glucose, Postprandial/2 Hour | |
| HDL / Cholesterol | |
| Heavy Metals (U): (Arsenic, Mercury Lead, Creatinine) | |
| Heavy Metals (U): (Arsenic, Mercury, Bismuth, Antimony) | |
| Heavy Metals Panel (U): (Arsenic, Mercury, Lead, Cadmium, Creatinine) | |
| Heavy Metals Panel, 24hr (U) (Arsenic, Cadmium, Lead, Mercury) | |
| Heavy Metals Screen (U): (Arsenic, Mercury, Selenium, Bismuth, Tellurium) | |
| HemoglobinA1C | |
| Hep A AB | |
| Hep A IGM | |
| Hep B Core | |
| Hep B Core IGM | |
| Hepatic Function panel (Alb, Tbili, Dbili, AP, AST, ALT) | |
| Hepatitis B Surface Antibody (QL) | |
| Hepatitis B Surface Antibody, Quant. | |
| Hepatitis B surface Antigen | |
| Hepatitis C Virus Antibody | |
| HIV testing (HIV-1 Ab Screen) | |
| LDH | |
| Lead (B) Industrial | |
| Lipid Panel | |
| Liver Function Profile PANEL (AP, ALT, AST, Tbili, Dbili, GGT, LDH, A/G, Ratio) | |
| Measles | |
| Measles, Mumps & Rubella IgG Antibody, Immune Status | |
| Metabolic Profile, Basic (Na, K, Cl, CO2, GLU, BUN, Creat) | |
| Mumps | |
| Reticulocyte Count | |
| Rubella Virus IGG AB By EIA | |
| Sickle Cell Screen | |
| Uric Acid (serum) | |
| Uric Acid (urine) | |
| Urinalysis, Reflex | |
| Varicella Zoster Virus IGG | |
| VISUAL FIELD EXAMINATION | |
| COLOR VISION EXAM | |
| PSYCHOLOGICAL SECURITY CLEARANCE SERVICES TELEHEALTH | |
| CARDIAC RISK PROFILE | |
| DEPTH PERCEPTION | |
| ZPP, Blood Protoporphyrins, zinc | |
| PHORIA | |
| BILIRUBIN, DIRECT | |
| SCREENING TEST OF VISUAL ACUITY | |
| Total |
| CLIN 2002: Service Type | Alabama | Alaska | Arizona | California | Colorado | Connecticut | Delaware | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | ||||||||||||||||||||||||||||||||
| High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price |
| Allergist |
| Audiologist |
| Cardiologist |
| Clarification |
| Dermatologist |
| Endocrinologist |
| Family Practice |
| Gastroenterologist |
| Hematologist |
| Infectious Disease |
| Internist |
| Nephrologist |
| Neurologist |
| Neuropsychiatrist |
| Neurosurgery |
| Oncologist |
| Ophthalmologist |
| Orthopedist |
| Otolaryngologist (E.N.T.) |
| Physical Medicine & Rehabilitation |
| Psychiatrist |
| Psychologist |
| Pulmonologist |
| Rheumatologist |
| Supplemental Request IME |
| Urologist |
| Total |
Tab 5 - Time & Material Year 4 Price Per Service - Year 4 Schedule Pricing Price Per Service - Year 4 Schedule Pricing Price Per Service - Year 4 Schedule Pricing Price Per Service - Year 4 Schedule Pricing
| CLIN 3001: Service Type | Alabama | Alaska | Arizona | California | Colorado | Connecticut | Delaware | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | ||||||||||||||||||||||||||||||||
| High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price |
| Audiometry (Stand Alone) | |
| Audiometry (w/Exam) | |
| Audiometry with CAOHC-Certified Technician (Add-on) | |
| Best Vision Screening (Stand Alone) | |
| Best Vision Screening (w/Exam) | |
| B-Reading | ` |
| Color Doppler | |
| Comprehensive Eye Exam | |
| Comprehensive Vision Screening (Stand Alone) | |
| Comprehensive Vision Screening (w/Exam) | |
| CT Chest (w/Contrast) | |
| CT Chest (w/out Contrast) | |
| Echocardiography | |
| EKG Overread | |
| Electrocardiogram (EKG) | |
| Examination - Brief | |
| Examination - Intermediate | |
| Examination - Comprehensive (Moderate Complexity) | |
| Examination - Comprehensive (High Complexity) | |
| Exercise Stress Test (EST) | |
| Exercise Stress Test (EST) - Thallium/Cardiolyte | |
| Immunization Administration (Injection) - Government Provided Vaccine | |
| Immunization Administration (Intranasal/Oral) - Government Provided Vaccine | |
| Independent Medical Review (up to 1/2 inch or 125 pages) | |
| Respirator Fit Test | |
| Respirator Medical Clearance (Stand Alone) | |
| Respirator Medical Clearance (w/Exam) | |
| Reviewing Medical Officer | |
| Spirometry (Stand Alone) | |
| Spirometry (w/Exam) | |
| Stress Echocardiogram | |
| Tuberculosis Skin Test and Reading (Stand Alone) | |
| Tuberculosis Skin Test and Reading (w/Exam) | |
| Vital Signs/Body Height and Weight (Stand Alone) | |
| Wellness Screening | |
| Wellness Screening - Prostate Cancer with PSA | |
| Wellness Vision Screening | |
| X-Ray - Chest (PA & LAT Views) | |
| X-Ray - Chest (PA View) | |
| Blood Type & Rh (ABO Group & RH Type) | |
| Cardio C-Reactive Protein (Cardio CRP) | |
| CBC (includes Diff/Plt) | |
| Comprehensive Metabolic Profile - NA, K, CL, GLU, BUN, Creat, CA, TP, ALB, Tbili, AP, AST, CO2 | |
| Direct Patient Pay Lipid Panel | |
| Glucose (B) | |
| Glucose 6 Phosphate Dehydrogenase | |
| Glucose, Postprandial/2 Hour | |
| HDL / Cholesterol | |
| Heavy Metals (U): (Arsenic, Mercury Lead, Creatinine) | |
| Heavy Metals (U): (Arsenic, Mercury, Bismuth, Antimony) | |
| Heavy Metals Panel (U): (Arsenic, Mercury, Lead, Cadmium, Creatinine) | |
| Heavy Metals Panel, 24hr (U) (Arsenic, Cadmium, Lead, Mercury) | |
| Heavy Metals Screen (U): (Arsenic, Mercury, Selenium, Bismuth, Tellurium) | |
| HemoglobinA1C | |
| Hep A AB | |
| Hep A IGM | |
| Hep B Core | |
| Hep B Core IGM | |
| Hepatic Function panel (Alb, Tbili, Dbili, AP, AST, ALT) | |
| Hepatitis B Surface Antibody (QL) | |
| Hepatitis B Surface Antibody, Quant. | |
| Hepatitis B surface Antigen | |
| Hepatitis C Virus Antibody | |
| HIV testing (HIV-1 Ab Screen) | |
| LDH | |
| Lead (B) Industrial | |
| Lipid Panel | |
| Liver Function Profile PANEL (AP, ALT, AST, Tbili, Dbili, GGT, LDH, A/G, Ratio) | |
| Measles | |
| Measles, Mumps & Rubella IgG Antibody, Immune Status | |
| Metabolic Profile, Basic (Na, K, Cl, CO2, GLU, BUN, Creat) | |
| Mumps | |
| Reticulocyte Count | |
| Rubella Virus IGG AB By EIA | |
| Sickle Cell Screen | |
| Uric Acid (serum) | |
| Uric Acid (urine) | |
| Urinalysis, Reflex | |
| Varicella Zoster Virus IGG | |
| VISUAL FIELD EXAMINATION | |
| COLOR VISION EXAM | |
| PSYCHOLOGICAL SECURITY CLEARANCE SERVICES TELEHEALTH | |
| CARDIAC RISK PROFILE | |
| DEPTH PERCEPTION | |
| ZPP, Blood Protoporphyrins, zinc | |
| PHORIA | |
| BILIRUBIN, DIRECT | |
| SCREENING TEST OF VISUAL ACUITY | |
| Total |
| CLIN 3002: Service Type | Alabama | Alaska | Arizona | California | Colorado | Connecticut | Delaware | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | ||||||||||||||||||||||||||||||||
| High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price |
| Allergist |
| Audiologist |
| Cardiologist |
| Clarification |
| Dermatologist |
| Endocrinologist |
| Family Practice |
| Gastroenterologist |
| Hematologist |
| Infectious Disease |
| Internist |
| Nephrologist |
| Neurologist |
| Neuropsychiatrist |
| Neurosurgery |
| Oncologist |
| Ophthalmologist |
| Orthopedist |
| Otolaryngologist (E.N.T.) |
| Physical Medicine & Rehabilitation |
| Psychiatrist |
| Psychologist |
| Pulmonologist |
| Rheumatologist |
| Supplemental Request IME |
| Urologist |
| Total |
Tab 6 - Time & Material Year 5 Price Per Service - Year 5 Schedule Pricing Price Per Service - Year 5 Schedule Pricing Price Per Service - Year 5 Schedule Pricing Price Per Service - Year 5 Schedule Pricing
| CLIN 4001: Service Type | Alabama | Alaska | Arizona | California | Colorado | Connecticut | Delaware | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | ||||||||||||||||||||||||||||||||
| High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price |
| Audiometry (Stand Alone) | |
| Audiometry (w/Exam) | |
| Audiometry with CAOHC-Certified Technician (Add-on) | |
| Best Vision Screening (Stand Alone) | |
| Best Vision Screening (w/Exam) | |
| B-Reading | ` |
| Color Doppler | |
| Comprehensive Eye Exam | |
| Comprehensive Vision Screening (Stand Alone) | |
| Comprehensive Vision Screening (w/Exam) | |
| CT Chest (w/Contrast) | |
| CT Chest (w/out Contrast) | |
| Echocardiography | |
| EKG Overread | |
| Electrocardiogram (EKG) | |
| Examination - Brief | |
| Examination - Intermediate | |
| Examination - Comprehensive (Moderate Complexity) | |
| Examination - Comprehensive (High Complexity) | |
| Exercise Stress Test (EST) | |
| Exercise Stress Test (EST) - Thallium/Cardiolyte | |
| Immunization Administration (Injection) - Government Provided Vaccine | |
| Immunization Administration (Intranasal/Oral) - Government Provided Vaccine | |
| Independent Medical Review (up to 1/2 inch or 125 pages) | |
| Respirator Fit Test | |
| Respirator Medical Clearance (Stand Alone) | |
| Respirator Medical Clearance (w/Exam) | |
| Reviewing Medical Officer | |
| Spirometry (Stand Alone) | |
| Spirometry (w/Exam) | |
| Stress Echocardiogram | |
| Tuberculosis Skin Test and Reading (Stand Alone) | |
| Tuberculosis Skin Test and Reading (w/Exam) | |
| Vital Signs/Body Height and Weight (Stand Alone) | |
| Wellness Screening | |
| Wellness Screening - Prostate Cancer with PSA | |
| Wellness Vision Screening | |
| X-Ray - Chest (PA & LAT Views) | |
| X-Ray - Chest (PA View) | |
| Blood Type & Rh (ABO Group & RH Type) | |
| Cardio C-Reactive Protein (Cardio CRP) | |
| CBC (includes Diff/Plt) | |
| Comprehensive Metabolic Profile - NA, K, CL, GLU, BUN, Creat, CA, TP, ALB, Tbili, AP, AST, CO2 | |
| Direct Patient Pay Lipid Panel | |
| Glucose (B) | |
| Glucose 6 Phosphate Dehydrogenase | |
| Glucose, Postprandial/2 Hour | |
| HDL / Cholesterol | |
| Heavy Metals (U): (Arsenic, Mercury Lead, Creatinine) | |
| Heavy Metals (U): (Arsenic, Mercury, Bismuth, Antimony) | |
| Heavy Metals Panel (U): (Arsenic, Mercury, Lead, Cadmium, Creatinine) | |
| Heavy Metals Panel, 24hr (U) (Arsenic, Cadmium, Lead, Mercury) | |
| Heavy Metals Screen (U): (Arsenic, Mercury, Selenium, Bismuth, Tellurium) | |
| HemoglobinA1C | |
| Hep A AB | |
| Hep A IGM | |
| Hep B Core | |
| Hep B Core IGM | |
| Hepatic Function panel (Alb, Tbili, Dbili, AP, AST, ALT) | |
| Hepatitis B Surface Antibody (QL) | |
| Hepatitis B Surface Antibody, Quant. | |
| Hepatitis B surface Antigen | |
| Hepatitis C Virus Antibody | |
| HIV testing (HIV-1 Ab Screen) | |
| LDH | |
| Lead (B) Industrial | |
| Lipid Panel | |
| Liver Function Profile PANEL (AP, ALT, AST, Tbili, Dbili, GGT, LDH, A/G, Ratio) | |
| Measles | |
| Measles, Mumps & Rubella IgG Antibody, Immune Status | |
| Metabolic Profile, Basic (Na, K, Cl, CO2, GLU, BUN, Creat) | |
| Mumps | |
| Reticulocyte Count | |
| Rubella Virus IGG AB By EIA | |
| Sickle Cell Screen | |
| Uric Acid (serum) | |
| Uric Acid (urine) | |
| Urinalysis, Reflex | |
| Varicella Zoster Virus IGG | |
| VISUAL FIELD EXAMINATION | |
| COLOR VISION EXAM | |
| PSYCHOLOGICAL SECURITY CLEARANCE SERVICES TELEHEALTH | |
| CARDIAC RISK PROFILE | |
| DEPTH PERCEPTION | |
| ZPP, Blood Protoporphyrins, zinc | |
| PHORIA | |
| BILIRUBIN, DIRECT | |
| SCREENING TEST OF VISUAL ACUITY | |
| Total |
| CLIN 4002: Service Type | Alabama | Alaska | Arizona | California | Colorado | Connecticut | Delaware | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | ||||||||||||||||||||||||||||||||
| High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price | Low Price | Average Price | High Price |
| Allergist |
| Audiologist |
| Cardiologist |
| Clarification |
| Dermatologist |
| Endocrinologist |
| Family Practice |
| Gastroenterologist |
| Hematologist |
| Infectious Disease |
| Internist |
| Nephrologist |
| Neurologist |
| Neuropsychiatrist |
| Neurosurgery |
| Oncologist |
| Ophthalmologist |
| Orthopedist |
| Otolaryngologist (E.N.T.) |
| Physical Medicine & Rehabilitation |
| Psychiatrist |
| Psychologist |
| Pulmonologist |
| Rheumatologist |
| Supplemental Request IME |
| Urologist |
| Total |
Tab 7 - Other Direct Costs
| Vaccines & Medications | Year 1 Schedule Pricing | Year 2 Schedule Pricing | Year 3 Schedule Pricing | Year 4 Schedule Pricing | Year 5 Schedule Pricing |
| Anthrax Vaccine | |||||
| Antiviral - Relenza | |||||
| Antiviral - Tamiflu | |||||
| Bay Gam (Immune Serum Globulin) (Gamma Globulin) - 2 ml vial | |||||
| Bay Gam (Immune Serum Globulin) (Gamma Globulin) - 10 ml vial | |||||
| Hepatitis A / Hepatitis B Combination Vaccine | |||||
| Hepatitis A Vaccine | |||||
| Hepatitis B Vaccine | |||||
| Influenza Virus Vaccine - Trivalent | |||||
| Influenza Virus Vaccine - Quadrivalent | |||||
| Influenza Virus Vaccination - Voucher Program | |||||
| Japanese Encephalitis Vaccine | |||||
| Measles, Mumps, and Rubella (MMR) Vaccine | |||||
| Meningococcal Vaccine | |||||
| Pneumococcal Vaccine - 13-Valent | |||||
| Pneumococcal Vaccine - 23-Valent | |||||
| Polio Vaccine | |||||
| Rabies Vaccine - Booster | |||||
| Rabies Vaccine (Intramuscular) | |||||
| Stamaril Vaccine | |||||
| Tetanus , Diphtheria, and Acellular Pertussis (Tdap) Vaccine | |||||
| Tetanus and Diphtheria (Td) Vaccine | |||||
| Travel Medication - Acetazolamide | |||||
| Travel Medication - Chloroquine | |||||
| Travel Medication - Ciprofloxacin | |||||
| Travel Medication - Doxycycline | |||||
| Travel Medication - Loperamide | |||||
| Travel Medication - Malarone | |||||
| Travel Medication - Mefloquine | |||||
| Typhoid Vaccine (Injection) | |||||
| Typhoid Vaccine (Oral) | |||||
| Varicella Vaccine | |||||
| Written Prescription - Ciprofloxacin | |||||
| Written Prescription - Doxycycline | |||||
| Yellow Fever Vaccine | |||||
| Expedited Service Fee | |||||
| Forms Completion Fee | |||||
| Missed Appointment (No-Show) / Late Cancellation Fee | |||||
| OCONUS Fee | |||||
| Out of Network Fee | |||||
| Preferred Provider Fee |
Tab 8 - Labor Categories
| ORDER PERIOD 1 - LABOR CATEGORIES | ||||||
| CLIN # | PWS Task Section | Labor Category | # of FTEs | Fully Loaded Hourly Rate | Total Labor Hours | Total Price |
| 0006 | ||||||
| 0006 | ||||||
| TOTALS CLIN 0006 | 0 | 0 | 0 |
| ORDER PERIOD 2 - LABOR CATEGORIES | ||||||
| CLIN # | PWS Task Section | Labor Category | # of FTEs | Fully Loaded Hourly Rate | Total Labor Hours | Total Price |
| 1006 | ||||||
| 1006 | ||||||
| TOTALS CLIN 1006 | 0 | 0 | 0 |
| ORDER PERIOD 3 - LABOR CATEGORIES | ||||||
| CLIN # | PWS Task Section | Labor Category | # of FTEs | Fully Loaded Hourly Rate | Total Labor Hours | Total Price |
| 2006 | ||||||
| 2006 | ||||||
| TOTALS CLIN 2006 | 0 | 0 | 0 |
| ORDER PERIOD 4 - LABOR CATEGORIES | ||||||
| CLIN # | PWS Task Section | Labor Category | # of FTEs | Fully Loaded Hourly Rate | Total Labor Hours | Total Price |
| 3006 | ||||||
| 3006 | ||||||
| TOTALS CLIN 3006 | 0 | 0 | 0 |
| ORDER PERIOD 5 - LABOR CATEGORIES | ||||||
| CLIN # | PWS Task Section | Labor Category | # of FTEs | Fully Loaded Hourly Rate | Total Labor Hours | Total Price |
| 4006 | ||||||
| 4006 | ||||||
| TOTALS CLIN 4006 | 0 | 0 | 0 |
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