Exhibit 14b Invoice Reports 4_4_4_2.xlsx

XLSX spreadsheet 140 KB Posted Oct 25, 2017

Attached to: Special Notice-Amendment 0009 Federal contract opportunity
Solicitation number: W15QKN-17-R-1042
Issued by: Department of the Army Materiel Command Contracting Command Picatinny Arsenal

About this file

Written by GovTribe AI · Dec 30, 2023

This document provides details on a federal contract opportunity for Reserve Health Readiness Program III services. The U.S. Army Contracting Command - New Jersey, on behalf of the Defense Health Agency, is seeking to award an indefinite-delivery, indefinite-quantity contract with a period of performance of five years to provide health readiness services to support Service Components of the Reserve Components. Required services include immunizations, physical examinations, pre-deployment health assessments, post-deployment health reassessments, mental health assessments, dental examinations and x-rays, dental treatment, laboratory services, occupational health services, and Periodic Health Assessments at clinics, call centers, and group events located throughout the U.S., its Territories, Germany, and at designated Service Component sites. The anticipated solicitation number is W15QKN-17-R-1042 and is expected to be issued on or about 30 September 2017 as a full and open competition with award as a firm-fixed-price and cost reimbursement contract.

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Other files attached to Special Notice-Amendment 0009, newest first.
File	Type	Posted
RHRP-3_Attachment_0007_Technical_Scenarios_Rev_2_May_2018.pdf	PDF	May 29, 2018
W15QKN-18-R-1000_Conformed_V05-29-18.pdf	PDF	May 29, 2018
RHRP-3_Attachment_0007_Technical_Scenario_Locations_2_May_2018.xlsx	XLSX spreadsheet	May 29, 2018
Copy_of_Attachment_-0004_Price_Matrix_Cost-Price_Vol_III-5-2-18.xlsx	XLSX spreadsheet	May 29, 2018
w15qkn-18-r-1000-0006.pdf	PDF	May 29, 2018
RHRP-3_Attachment_0006_Basis_of_Award_2_May_2018.pdf	PDF	May 29, 2018
Industry_Questions_2-15-2018.pdf	PDF	Feb 15, 2018
Conform_-_W15QKN-18-R-1000.docx	DOCX document	Feb 15, 2018
Attachment_0007_Technical_Scenarios_24_Jan_2018.pdf	PDF	Feb 15, 2018
Attachment_0006_basis_of_award_jan_24_18.pdf	PDF	Feb 15, 2018
RHRP-3_Amend_0004_Attachments.zip	ZIP file	Jan 30, 2018
W15QKN-18-R-1000-0004_(Released).pdf	PDF	Jan 30, 2018
W15QKN-18-R-1000-0002_(Released).pdf	PDF	Dec 14, 2017
RHRP-3_Preproposal_Conference_Attendee_List.pdf	PDF	Dec 8, 2017
W15QKN-18-R-1000-0001_(Released).pdf	PDF	Dec 8, 2017
Q-A_for_Release_12-8-(clean)-kk.pdf	PDF	Dec 8, 2017
Exhibit_14p_Detail_Report_with_Dental_Event_Reclassification_4.4.4.25.xlsx	XLSX spreadsheet	Nov 29, 2017
Exhibit_2c_DD_Form_3024_OFFICIAL_LOCKED.pdf	PDF	Nov 29, 2017
Exhibit_14s_Group_Event_POC_Survey_Results_4.4.4.15.xlsx	XLSX spreadsheet	Nov 29, 2017
Exhibit_14f_Avoidable_Costs_YTD__4.4.4.20.xlsx	XLSX spreadsheet	Nov 29, 2017
Attch_0008-_Preproposal_Conference_Intent_to_Participate.pdf	PDF	Nov 29, 2017
D001_Quality_Assurance_Plan_RHRP-3.pdf	PDF	Nov 29, 2017
Exhibit_17_Record_Layout_PHA_DD3024_201604_v1.xlsx	XLSX spreadsheet	Nov 29, 2017
Exhibit_14g_PDHRA_and_MHA_Monthly_Activity_Management_Report_4.4.4.22.xlsx	XLSX spreadsheet	Nov 29, 2017
Exhibit_11a_DHA_IT_specifications_HAIMS_RHRP.docx	DOCX document	Nov 29, 2017
Exhibit_8_USAR_and_ARNG_IT_Specifications.doc	DOC document	Nov 29, 2017
Exhibit_14h_RHRP_Event_Planning_and_Forecast_4.4.3.4.xlsx	XLSX spreadsheet	Nov 29, 2017
PWS_-_22_Nov_2017.pdf	PDF	Nov 29, 2017
Exhibit_11b_DHA_IT_specifications_JLV_RHRP.docx	DOCX document	Nov 29, 2017
PWS_-_22_Nov_2017.pdf	PDF	Nov 22, 2017
Attachment 0004 Price Matrix Cost-Price Vol III 9-30-17-dl.xlsx	XLSX spreadsheet	Oct 25, 2017
Exhibit 14g PDHRA and MHA Monthly Activity Management Report 4_4_4_22.xlsx	XLSX spreadsheet	Oct 25, 2017
Exhibit 14h RHRP_Event Planning and Forecast 4.4.3.4.xlsx	XLSX spreadsheet	Oct 25, 2017
Attachment 0007 Technical Scenarios.docx	DOCX document	Oct 25, 2017
Exhibit 13 Checklist and Certification for Safeguarding Unclassified DoD.docx	DOCX document	Oct 25, 2017
D001 Quality Assurance Plan.pdf	PDF	Oct 25, 2017
Exhibit 14e InClinic Services By Service Date 4_4_4_18.xlsx	XLSX spreadsheet	Oct 25, 2017
Attachment 0001 PWS List of Exhibits 09-20-17.doc	DOC document	Oct 25, 2017
Attachment 0006 Basis of Award 9-30-17.docx	DOCX document	Oct 25, 2017
B004 Training Certifications.pdf	PDF	Oct 25, 2017
RHRP-3_Draft_PWS_Attachments_2_of_3.zip	ZIP file	Oct 25, 2017
RHRP-3_Draft_PWS_Attachments_1_of_3.zip	ZIP file	Oct 25, 2017
Attachment 0003 Performance Risk Assessment Questionaire.docx	DOCX document	Oct 25, 2017
Exhibit 14a Post Exercise Report 4_4_2_4.xlsx	XLSX spreadsheet	Oct 25, 2017
Attachment 0002 Disclosure of Lobbying Activities SF LLL.pdf	PDF	Oct 25, 2017
RHRP-3_Draft_DD_1423_CDRLs.zip	ZIP file	Oct 25, 2017
C003 Continuity of Operations Plan.pdf	PDF	Oct 25, 2017
Exhibit 14 Report Matrix.xlsx	XLSX spreadsheet	Oct 25, 2017
Attachment 0001 PWS 30 Sep 17.pdf	PDF	Oct 25, 2017
A001 Post Award Conference.pdf	PDF	Oct 25, 2017

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HT0011-13-D-0001-0010

Reserve Health Readiness Program II (RHRP II) Invoice Report

Mental Health Assessments for Air Force Reserve Command and Air National Guard MHA (AFRC, ANG)

Defense Health Agency

7700 Arlington Blvd

Falls Church VA 22042

HT0011-13-D-0001-0010-04

Awarded:

Invoiced Thru Report Period

Invoiced During Report Period

Task Order Total:

360,000

2013-09-16

to 2016-09-30

15-Oct-16

31-Oct-16

15-Nov-16

30-Nov-16

15-Dec-16

31-Dec-16

15-Jan-17

31-Jan-17

15-Feb-17

28-Feb-17

15-Mar-17

31-Mar-17

15-Apr-17

30-Apr-17

15-May-17

31-May-17

15-Jun-17

30-Jun-17

15-Jul-17

31-Jul-17

15-Aug-17

31-Aug-17

15-Sep-17

30-Sep-17

to 2016-12-31

TASK ORDER BALANCE

Element

Procedure #

Qty

Unit Price

Total

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

H. MENTAL HEALTH ASSESSMENT (MHA) - CALL CENTER

MHA, call center, price per completed MHA when positive screen

MHA, call center, price per completed MHA when negative screen

R. MISCELLANEOUS FEE

Scheduling without QA (price per SM)

TOTAL PROCEDURES CLIN 0001

0001

TOTAL TRAVEL CLIN 0002

0002

TOTAL SHIPPING (Other) CLIN 0004

0004

TASK ORDER TOTAL

HT0011-13-D-0001-0015

Reserve Health Readiness Program II (RHRP II) Invoice Report

US Coast Guard (USCG)

Defense Health Agency

7700 Arlington Blvd

Falls Church VA 22042

HT0011-13-D-0001-0015-03

Awarded:

9/16/13

Invoiced Thru Report Period

Invoiced During Report Period

Task Order Total:

2013-09-16

to 2016-09-30

15-Oct-16

31-Oct-16

15-Nov-16

30-Nov-16

15-Dec-16

31-Dec-16

15-Jan-17

31-Jan-17

15-Feb-17

28-Feb-17

15-Mar-17

31-Mar-17

15-Apr-17

30-Apr-17

15-May-17

31-May-17

15-Jun-17

30-Jun-17

15-Jul-17

31-Jul-17

15-Aug-17

31-Aug-17

15-Sep-17

30-Sep-17

to 2016-12-31

TASK ORDER BALANCE

Element

Procedure #

Qty

Unit Price

Total

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

A. PHYSICAL EXAMS - IN-CLINIC

Retention exam, younger than 39, male

Retention exam, younger than 39, female

Retention exam, 39 and older, male

Retention exam, 39 and older, female

Airborne exam

Accession exam, male

Accession exam, female

Physical exam, Chapter 3, AGR, younger than 39, male

Physical exam, Chapter 3, AGR, younger than 39, female

Physical exam, Chapter 3, AGR, 39 and older, male

A10

Physical exam, Chapter 3, AGR, 39 and older, female

A11

Air Force retention exam

A12

Firefighter / CBRN exam, younger than 39, male

A13

Firefighter / CBRN exam, younger than 39, female

A14

Firefighter / CBRN exam, 39 and older, male

A15

Firefighter / CBRN exam, 39 and older, female

A16

B. PERIODIC HEALTH ASSESSMENT (PHA) & FOCUSED EXAM - IN-CLINIC

MARFORRES / USCG / USNR

MARFORRES / USCG / USNR, PHA, in-clinic, price per completed PHA

C. PHA & FOCUSED EXAM - GROUP EVENT

MARFORRES / USCG / USNR

MARFORRES / USCG / USNR, PHA, group event, TIER 1 (minimum 30 PHAs to schedule; price per PHA when total PHAs completed at group event equal 40 or less)

MARFORRES / USCG / USNR, PHA, group event, TIER 2 (minimum 30 PHAs to schedule; price per PHA when total PHAs completed at group event equal 41 to 80)

MARFORRES / USCG / USNR, PHA, group event, TIER 3 (minimum 30 PHAs to schedule; price per PHA when total PHAs completed at group event equal 81 or more)

D. PHA LITE & FOCUSED EXAM - GROUP EVENT

PHA lite, group event, TIER 1 (minimum 30 PHA lites to schedule; price per PHA lite when total PHA lites completed at group event equal 40 or less)

PHA lite, group event, TIER 2 (minimum 30 PHA lites to schedule; price per PHA lite when total PHA lites completed at group event equal 41 to 80)

PHA lite, group event, TIER 3 (minimum 30 PHA lites to schedule; price per PHA lite when total PHA lites completed at group event equal 81 or more)

E. PHA BEHAVIORAL HEALTH SPECIALIST STAND ALONE - CALL CENTER / GROUP EVENT

PHA Behavioral Health Specialist, call center, price per call

PHA Behavioral Health Specialist, group event (minimum 60 scheduled PHAs; price for up to 60 PHAs)

F. POST DEPLOYMENT HEALTH RE-ASSESSMENT (PDHRA) - CALL CENTER

PDHRA, call center, price per completed DD Form 2900

G. PDHRA - GROUP EVENT

PDHRA, group event, TIER 1 (minimum 30 PDHRAs to schedule; price per PDHRA when total PDHRAs completed at group event equal 40 or less)

PDHRA, group event, TIER 2 (minimum 30 PDHRAs to schedule; price per PDHRA when total PDHRAs completed at group event equal 41 to 80)

PDHRA, group event, TIER 3 (minimum 30 PDHRAs to schedule; price per PDHRA when total PDHRAs completed at group event equal 81 or more)

H. MENTAL HEALTH ASSESSMENT (MHA) - CALL CENTER

MHA, call center, price per completed MHA when positive screen

MHA, call center, price per completed MHA when negative screen

I. MHA - GROUP EVENT

MHA, group event, TIER 1 (minimum 30 MHAs to schedule; price per MHA when total MHAs completed at group event equal 40 or less)

MHA, group event, TIER 2 (minimum 30 MHAs to schedule; price per MHA when total MHAs completed at group event equal 41 to 80)

MHA, group event, TIER 3 (minimum 30 MHAs to schedule; price per MHA when total MHAs completed at group event equal 81 or more)

J. AUDIO w/ Exam (PHA / Physical Exam) - IN-CLINIC

Annual Audiometric Screen with MEDPROS Update

Comprehensive audio exam / pure tone air and bone conduction testing

SPRINT (Speech Recognition in Noise Test)

JJ. AUDIO STAND ALONE - IN-CLINIC

Acoustic reflex testing threshold

JJ1

Audio Hearing Test - pure tone air

JJ2

Audiometry - pure tone air and bone conduction testing

JJ3

Consultation w/ Otolaryngologist

JJ4

DOHERS entry

JJ5

Evoked acoustic emission; limited (single stimulus level, either transient or distortion products)

JJ6

Speech audiometry threshold; w/ speech recognition

JJ7

Sprint

JJ8

Tympanometry

JJ9

JJJ. AUDIO - GROUP EVENT

Annual Audiometric Screen with MEDPROS Update (minimum 50 screens per day to schedule; price per completed screen)

JJJ1

Comprehensive audio exam / pure tone air and bone conduction testing (minimum 25 tests per day to schedule; price per completed test)

JJJ2

DOHERS entry

JJJ3

K. VISION w/ Exam (PHA / Physical Exam) - IN-CLINIC

Comprehensive eye exam

Eye examination with refraction and prescription

Tonometry

Vision Screen with color and with & without correction

KK. VISION STAND ALONE - IN-CLINIC

Comprehensive eye exam

KK1

Eye examination with refraction and prescription

KK2

Tonometry

KK3

Vision - Monocular

KK4

Vision Screen with color and with & without correction

KK5

KKK. VISION - GROUP EVENT

Comprehensive eye exam (minimum 25 exams per day to schedule; price per completed exam)

KKK1

Eye exam with refraction and prescription, group event (minimum 50 exams per day to schedule; price per completed exam)

KKK2

Vision screen, group event, TIER 1 (minimum 30 screens to schedule; price per completed screen when total screens completed at group event equal 40 or less)

KKK3

Vision screen, group event, TIER 2 (minimum 30 screens to schedule; price per completed screen when total screens completed at group event equal 41 to 80)

KKK4

Vision screen, group event, TIER 3 (minimum 30 screens to schedule; price per completed screen when total screens completed at group event equal 81 or more)

KKK5

L. IMMUNIZATION w/ Exam (PHA / Physical Exam) - IN-CLINIC

Hepatitis A

Hepatitis B

Influenza - Injectable

Rabies Titer

PPD

Tdap

Tetanus and Diphtheria

Twinrix

Varicella

Varicella titer

L10

LL. IMMUNIZATION STAND ALONE - IN-CLINIC

Hepatitis A

LL1

Hepatitis B

LL2

Influenza - Injectable

LL3

Japanese encephalitis

LL4

Meningococcus

LL5

Polio

LL6

Rabies

LL7

Rabies Titer

LL8

PPD

LL9

Tdap

LL10

Tetanus and Diphtheria

LL11

Typhoid

LL12

Twinrix

LL13

Varicella

LL14

Varicella titer

LL15

Yellow fever

LL16

LLL. IMMUNIZATION - GROUP EVENT

Administration of vaccine, group event, TIER 1 (minimum 60 administrations to schedule; price per completed administration when total administrations completed at group event equal 60 or less)

LLL1

Administration of vaccine, group event, TIER 2 (minimum 60 administrations to schedule; price per completed administration when total administrations completed at group event equal 61 to 120)

LLL2

Administration of vaccine, group event, TIER 3 (minimum 60 administrations to schedule; price per completed administration when total administrations completed at group event equal 121 or more)

LLL3

Anthrax (6 shot series) (Government will provide vaccine)

LLL4

Globulin, Immune

LLL5

Hepatitis A (2 shot series)

LLL6

Hepatitis B (3 shot series)

LLL7

Inactivated Polio Vaccine (IPV)

LLL8

Influenza

LLL9

Japanese Encephalitis

LLL10

Measles, Mumps, Rubella (MMR)

LLL11

Menactra

LLL12

PPD

LLL13

Rabies (3 shot series)

LLL14

Rabies Titer

LLL15

Storage of DoD Vaccine

LLL16

Tdap

LLL17

Tetanus and Diphtheria

LLL18

Typhoid (injectable or oral)

LLL19

Varicella

LLL20

Varicella titer

LLL21

Yellow fever

LLL22

M. LABORATORY SERVICE w/ Exam (PHA / Physical Exam) - IN-CLINIC

AGR labs

Blood type and determination of Rh factor w/ venipuncture

Chlamydia, DNA by SDA (urine)

Chlamydia / Gonorrhea (by swab)

Chlamydia / Gonorrhea (reflex from swab)

CVSP

DNA test

Gonorrhea, DNA by SDA (urine)

G6PD

HIV test

M10

Pregnancy, urine

M11

PSA

M12

PSA w/ rectal exam

M13

Rectal exam with stool for guaiac

M14

Sickle cell screening test w/ confirmation by reflex to hemoglobulinopathy

M15

Stool occult for blood (1 slide)

M16

Stool occult for blood (2 slide)

M17

Stool occult for blood (3 slide)

M18

Thin prep w/ preventive exam (pelvic) to collect specimen

M19

Phlebotomy (blood draw)

M20

MM. LABORATORY SERVICE STAND ALONE - IN-CLINIC

AGR labs

MM1

Blood type and determination of Rh factor w/ venipuncture

MM2

Chlamydia, DNA by SDA (urine)

MM3

CVSP

MM4

DNA test (no lab) - use military labor and DNA card

MM5

Gonorrhea, DNA by SDA (urine)

MM6

G6PD

MM7

HIV test

MM8

Phlebotomy (blood draw)

MM9

Pregnancy, urine

MM10

PSA

MM11

PSA w/ rectal exam

MM12

Rectal exam w/ stool for guaiac

MM13

Sickle cell screening test w/ confirmation by reflex to hemoglobulinopathy

MM14

Stool occult for blood (1 slide)

MM15

Stool occult for blood (2 slide)

MM16

Stool occult for blood (3 slide)

MM17

Thin prep w/ preventive exam (pelvic) to collect specimen

MM18

MMM. LABORATORY SERVICE - GROUP EVENT

Blood type and determination of Rh factor w/ venipuncture

MMM1

Chlamydia, DNA by SDA (urine)

MMM2

CVSP

MMM3

CVSP (Cholestech) (minimum 25 screens per day to schedule; price per completed screen)

MMM4

Gonorrhea, DNA by SDA (urine)

MMM5

G6PD Testing

MMM6

HIV testing, group event, TIER 1 (minimum 50 tests to schedule; price per completed test when total tests completed at group event equal 40 or less)

MMM7

HIV testing, group event, TIER 2 (minimum 50 tests to schedule; price per completed test when total tests completed at group event equal 41 to 80)

MMM8

HIV testing, group event, TIER 3 (minimum 50 tests to schedule; price per completed test when total tests completed at group event equal 81 or more)

MMM9

HPV lab

MMM10

Phlebotomy (CVSP, DNA, G6PD,HIV, Rabies Titer, Varicella Titer) (minimum 30 draws per day to schedule; price per completed draw)

MMM11

Pregnancy Test (minimum 30 tests per day to schedule; price per completed test)

MMM12

PSA

MMM13

PSA w/ rectal exam

MMM14

Status hCG Strip (Kit Only)

MMM15

Stool occult for blood (1 slide)

MMM16

Stool occult for blood (2 slide)

MMM17

Stool occult for blood (3 slide)

MMM18

Thin prep w/ preventive exam (pelvic) to collect specimen

MMM19

N. MISCELLANEOUS MEDICAL SERVICE w/ Exam (PHA / Physical Exam) - IN-CLINIC

Breast exam

Chest x-ray, posterior-anterior view

EKG, resting

Mammography

Chest x-ray, posterior-anterior and lateral views with interpretation

NN. MISCELLANEOUS MEDICAL SERVICE STAND ALONE - IN-CLINIC

Breast exam

NN1

B-read

NN2

Chest x-ray, posterior-anterior view

NN3

EKG, resting

NN4

Mammography

NN5

NNN. MISCELLANEOUS MEDICAL SERVICE - GROUP EVENT

Breast exam

NNN1

EKG, resting (minimum 20 EKGs per day to schedule; price per completed EKG)

NNN2

O. DENTAL SERVICE - IN-CLINIC

Annual Dental Exam (Periodic Oral Examination)

Annual Dental Exam (Comprehensive Oral Examination)

Dental bitewing, single film

Dental bitewing, set of two films

Dental bitewing, set of three films

Dental bitewing, set of four films as indicated

Complete series x-ray

Cone beam – 2 dimensional image reconstruction

Cone beam – 3 dimensional image reconstruction

Intraoral periapical x-ray

O10

Panographic x-ray

O11

OO. DENTAL SERVICE - GROUP EVENT

Dental exam, comprehensive oral evaluation, group event, TIER 1 (minimum 50 exams to schedule; price per exam when total exams completed at group event equal 40 or less)

OO1

Dental exam, comprehensive oral evaluation, group event, TIER 2 (minimum 50 exams to schedule; price per exam when total exams completed at group event equal 41 to 80)

OO2

Dental exam, comprehensive oral evaluation, group event, TIER 3 (minimum 50 exams to schedule; price per exam when total exams completed at group event equal 81 or more)

OO3

Dental bitewings, set of 4 films, group event, TIER 1 (minimum 20 sets to schedule; price per set when total sets completed at group event equal 40 or less)

OO4

Dental bitewings, set of 4 films, group event, TIER 2 (minimum 20 sets to schedule; price per set when total sets completed at group event equal 41 to 80)

OO5

Dental bitewings, set of 4 films, group event, TIER 3 (minimum 20 sets to schedule; price per set when total sets completed at group event equal 81 or more)

OO6

Panographic radiograph, group event, TIER 1 (minimum 20 radiographs to schedule; price per radiograph when total radiographs completed at group event equal 40 or less)

OO7

Panographic radiograph, group event, TIER 2 (minimum 20 radiographs to schedule; price per radiograph when total radiographs completed at group event equal 41 to 80)

OO8

Panographic radiograph, group event, TIER 3 (minimum 20 radiographs to schedule; price per radiograph when total radiographs completed at group event equal 81 or more)

OO9

Dental exam, comprehensive oral evaluation, group in-clinic (minimum 15 exams to schedule; price per completed exam; transportation of Service Members is responsibility of Service Component)

OO10

P. DENTAL TREATMENT SERVICE - IN-CLINIC

Consultation Dental Exam

Office visit after hours

Hospital call

Detailed and extensive oral evaluation

Comprehensive periodontal evaluation

Amalgam, One Surface, Permanent

Amalgam, Two Surfaces, Permanent

Amalgam, Three Surfaces, Permanent

Amalgam, Four or More Surfaces, Permanent

Apicoectomy - Anterior

P10

Apicoectomy - Bicuspid

P11

Apicoectomy - Molar - first root

P12

Apicoectomy - Molar - each add'l root

P13

Resin Based Composite, one surface

P14

Resin Based Composite, two surfaces

P15

Resin Based Composite, three surfaces

P16

Resin Based Composite, four surface

P17

Resin (1) one surface posterior

P18

Resin (2) two surface posterior

P19

Resin (3) three surface posterior

P20

Resin (4) four or more posterior

P21

Anterior (excluding final restoration)

P22

Bicuspid (excluding final restoration)

P23

Molar (excluding final restoration)

P24

Core build up including pins

P25

Prefab post & core

P26

Extraction, single tooth

P27

Extraction, each additional tooth

P28

Extraction deciduous tooth

P29

Complete bony extraction

P30

Surgical removal of erupted tooth

P31

Removal of impacted tooth-completely bony

P32

Removal of impacted tooth soft tissue

P33

Removal of impacted tooth partial bony

P34

Analgesic Nitrous

P35

IV anesthesia first 30 minutes

P36

IV anesthesia each additional 15 minutes

P37

Local anesthesia

P38

Regional block anesthesia

P39

Deep Sedation / general anesthesia first 30 minutes

P40

Deep Sedation / general anesthesia each additional 15 minutes

P41

Non-intravenous conscious sedation

P42

Therapeutic drug injection - includes antibiotic or injection of sedative

P43

Palliative treatment of dental pain

P44

Oral antibiotics (given at the office)

P45

Periodontal scaling and root planing

P46

Perio scaling and root planing per quadrant

P47

Full mouth debridement

P48

Gingivectomy, 1-3 teeth

P49

Gingivectomy, 4 or more teeth

P50

Sedative filling

P51

Pin retention in addition to filling

P52

Retrograde filling

P53

Pulp cap (indirect)

P54

Pulp cap (direct)

P55

Pulpotomy

P56

Pulpal debridement

P57

Pulp vitality tests

P58

Incomplete endo therapy

P59

Retreatment of molar endo

P60

Immediate denture maxillary

P61

Immediate denture mandibular

P62

Partial denture maxillary (resin base)

P63

Partial denture mandibular (resin base)

P64

Adjust maxillary denture

P65

Add tooth to existing partial denture

P66

Mandibular partial denture flexible base

P67

Add clasp to existing partial denture

P68

Reline mandibular partial denture (chair side)

P69

Reline complete maxillary denture (laboratory)

P70

Reline mandibular partial denture (laboratory)

P71

Reline complete maxillary denture (chair side)

P72

Reline complete mandibular denture (chair side)

P73

Reline maxillary partial denture (chair side)

P74

Interim partial denture (maxillary)

P75

Interim partial denture (mandibular)

P76

Recement fixed partial denture

P77

Adjust complete denture - mandibular

P78

Adjust partial denture - maxillary

P79

Adjust partial denture - mandibular

P80

Repair broken complete denture base

P81

Replace missing or broken teeth - complete denture (each tooth)

P82

Reline complete mandibular denture (laboratory)

P83

Reline maxillary partial denture (laboratory)

P84

Complete denture maxillary

P85

Complete denture mandibular

P86

Maxillary partial denture - cast metal

P87

Mandibular partial denture - cast metal

P88

Repair resin denture base

P89

Repair or replace broken clasp - partial denture

P90

Replace missing or broken teeth (partial)

P91

Rebase complete maxillary denture

P92

Rebase complete mandibular denture

P93

Fixed partial denture sectioning

P94

Fixed partial denture repair, by report

P95

Surgical removal of residual root tips

P96

Primary closure of sinus perforation

P97

Biopsy of oral tissue (soft)

P98

Biopsy of oral tissue - hard

P99

Alveoloplasty in conjunction with extractions

P100

Alveoloplasty in conjunction with extractions per quad

P101

Alveoloplasty not in conjunction with extractions

P102

Complicated suture

P103

Complicated suture - greater than 5 cm

P104

Repair of maxillofacial hard or softer tissue defect

P105

Excision of malignant tumor (lesion diameter greater than 1.25 cm)

P106

Excision of malignant tumor - lesion diameter up to 1.25 cm

P107

Excision of benign lesion - lesion diameter less than 1.25 cm

P108

Excision of malignant lesion up to 1.25 cm

P109

Excision of malignant lesion greater than 1.25 cm

P110

Excision of malignant lesion, complicated

P111

Excision of benign lesion greater than 1.25 cm

P112

Excision of benign lesion, complicated

P113

Removal of odontogenic cyst / tumor - lesion diameter up to 1.25cm

P114

Removal of benign nonodontogenic cyst or tumor - lesion diameter up to 1.25 cm

P115

Removal of benign nonodontogenic cyst or tumor - lesion diameter greater than 1.25 cm

P116

Removal of benign odontogenic cyst or tumor (lesion diameter greater than 1.25 cm)

P117

Removal of lateral exostosis (maxilla or mandible)

P118

Removal of torus mandibularis

P119

Removal of torus palatinus

P120

Brush biopsy - transepithelial sample collection

P121

Destruction of lesion by physical / chemical

P122

Crown - porcelain fused to high noble metal

P123

Crown - porcelain fused to noble metal

P124

Crown - full cast high noble metal

P125

Crown - full cast noble metal

P126

Temporary crown (fractured tooth)

P127

Crown repair, by report

P128

Recement crown

P129

Stainless steel crown

P130

Resin based composite crown, anterior

P131

Post removal

P132

Cast post and core in addition to crown

P133

Provisional crown

P134

Prefabricated resin crown

P135

Prefabricated stainless steel crown, primary tooth

P136

Diagnostic casts

P137

Retreatment of previous RCT - anterior

P138

Retreatment of previous RCT - bicuspid

P139

Oroantral fistula closure

P140

Osseous surgery (four or more teeth)

P141

Distal or proximal wedge procedure

P142

Internal root repair of perforation defects

P143

Osseous surgery (including flap entry & closure) - one to three contiguous teeth or bounded teeth spaces per quadrant

P144

Free soft tissue graft procedure (including donor site surgery)

P145

Treatment of complications (post surgical)

P146

Treatment of root canal obstruction - non surgical

P147

Apexification / recalcification - initial visit

P148

Gingival flap procedure and root planing - 4 or more teeth per quadrant

P149

Bone replacement graft - first site in quadrant

P150

Biologic material to aid in soft and osseous tissue regeneration

P151

Incision and drainage of abscess-soft tissue

P152

Removal of foreign body from mucosa, skin or subcutaneous alveolar tissue

P153

Removal of reaction producing foreign bodies, musculoskeletal

P154

Removal of loose or sloughed-off dead bone caused by infection or reduced blood supply

P155

Osseous, osteoperiosteal, or cartilage graft of the mandible or facial bone - autogenous or nonautogenous

P156

Frenulectomy (frenum are muscle fibers covered by a mucous membrane that attaches the cheek, lips, and / or tongue to associated dental mucosa)

P157

Appliance removal (not by dentist who placed it) includes removal of archbar

P158

Removable appliance therapy an example would be for treating tongue thrusting

P159

Occlusal guard - removable dental appliance, designed to minimize the effects of grinding and other occlusal factors

P160

Occlusal adjustment

P161

Repair of orthodontic appliance

P162

Replacement of lost or broken retainer

P163

PP. DENTAL TREATMENT SERVICE - GROUP EVENT

Mobile vehicle, dental treatment (limited to dental treatment services listed in Attachment 1; price per vehicle per day)

PP1

Mobile vehicle, dental bitewings, set of 4 films as indicated (price per set)

PP2

Prescription Authorization for Dental Restorative Services

PP3

Q. MEDICAL AND DENTAL RECORD PROCESSING - CONTRACTOR LOCATION

Record Maintenance - Medical

Record Maintenance - Dental

Record Review - Medical

Record Review - Dental

Digitization of Medical Records (includes x-rays)

Digitization of Dental Records (includes x-rays)

Historical Update - Medical

Historical Update - Dental

R. MISCELLANEOUS FEE

Vaccine Destruction (per 1 lb.)

Scheduling without QA (price per SM)

S. CANCELLATION FEE

Cancellation fee, in-clinic service (price per visit)

Cancellation fee, group event, assessment service including MHA, PDHRA, PHA, PHA lite (price per individual service) MHA

Cancellation fee, group event, dental service (price per individual service) Exam

Cancellation fee, group event, audio or vision service (price per individual service) Audio

Cancellation fee, group event, immunization, laboratory, or miscellaneous medical service (price per individual service) Imm

T. NO SHOW FEE

No show fee, in-clinic service (price per visit)

No show fee, group event, assessment service including MHA, PDHRA, PHA, PHA lite (price per individual service) MHA

No show fee, group event, dental service (price per individual service) Exam

No show fee, group event, audio or vision service (price per individual service) Audio

No show fee, group event, immunization, laboratory, or miscellaneous medical service (price per individual service) Imm

TOTAL PROCEDURES CLIN 0001

0001

TOTAL TRAVEL CLIN 0002

0002

TOTAL SHIPPING (Other) CLIN 0004

0004

TASK ORDER TOTAL

Beginning Balance per CLIN adjusted per Task Order Modification

HT0011-13-D-0001-0056

Reserve Health Readiness Program II (RHRP II) Invoice Report

Post-Deployment Health Reassessments for Reserve Components (PDHRA RC)

Defense Health Agency

7700 Arlington Blvd

Falls Church VA 22042

HT0011-13-D-0001-0056

Awarded:

Invoiced Thru Report Period

Invoiced During Report Period

Task Order Total:

2013-09-16

to 2016-09-30

15-Oct-16

31-Oct-16

15-Nov-16

30-Nov-16

15-Dec-16

31-Dec-16

15-Jan-17

31-Jan-17

15-Feb-17

28-Feb-17

15-Mar-17

31-Mar-17

15-Apr-17

30-Apr-17

15-May-17

31-May-17

15-Jun-17

30-Jun-17

15-Jul-17

31-Jul-17

15-Aug-17

31-Aug-17

15-Sep-17

30-Sep-17

to 2016-12-31

TASK ORDER BALANCE

Element

Procedure #

Qty

Unit Price

Total

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

Qty

Amount

F. POST DEPLOYMENT HEALTH RE-ASSESSMENT (PDHRA) - CALL CENTER

PDHRA, call center, price per completed DD Form 2900

G. PDHRA - GROUP EVENT

PDHRA, group event, TIER 1 (minimum 30 PDHRAs to schedule; price per PDHRA when total PDHRAs completed at group event equal 40 or less)

PDHRA, group event, TIER 2 (minimum 30 PDHRAs to schedule; price per PDHRA when total PDHRAs completed at group event equal 41 to 80)

PDHRA, group event, TIER 3 (minimum 30 PDHRAs to schedule; price per PDHRA when total PDHRAs completed at group event equal 81 or more)

Q. MEDICAL AND DENTAL RECORD PROCESSING - CONTRACTOR LOCATION

Record Maintenance - Medical

Record Maintenance - Dental

Record Review - Medical

Record Review - Dental

Digitization of Medical Records (includes x-rays)

Digitization of Dental Records (includes x-rays)

Historical Update - Medical

Historical Update - Dental

R. MISCELLANEOUS FEE

Scheduling without QA (price per SM)

S. CANCELLATION FEE

Cancellation fee, in-clinic service (price per visit)

Cancellation fee, group event, assessment service including MHA, PDHRA, PHA, PHA lite (price per individual service)

Cancellation fee, group event, dental service (price per individual service) Exam

Cancellation fee, group event, audio or vision service (price per individual service) Audio

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.