Mock Pricing Scenerio Sheet.DOCX

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OKNG ANNUAL OCCUPATIONAL MEDICAL
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W912L6-20-R-0007
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Proposal Pricing Sheet

1. RATE PROPOSAL: (if you do not offer a particular test, have a more appropriate test code, or have a new test code identifier please notate the changes on this form)

1.1 Base Period (2 Years)

Test Panel “01” Rate: $______

Test Panel “02” Rate: $ ______

Test Panel “03” Rate: $ ______

Test Panel “04” Rate: $_______

Test Panel “05” Rate: $_______

Lab 1: Complete Blood Count (CBC) Rate: $________

Lab 2: Complete Metabolic Profile (CMP) Rate: $ _________

Lab 3: Blood Lead / ZPP Rate: $ __________

Lab 4: Blood Cadmium Rate: $ _________

Lab5: Benzene Clearance Rate: $ _________

Lab 6: Urine Chromium Rate: $ __________

Lab 7: Chext X-Ray Rate: $ __________

Lab 8: Electrocardiogram (EKG) Rate: $ _______

1.2 Option Period 1

Test Panel “01” Rate: $______

Test Panel “02” Rate: $ ______

Test Panel “03” Rate: $ ______

Test Panel “04” Rate: $_______

Test Panel “05” Rate: $_______

Lab 1: Complete Blood Count (CBC) Rate: $________

Lab 2: Complete Metabolic Profile (CMP) Rate: $ _________

Lab 3: Blood Lead / ZPP Rate: $ __________

Lab 4: Blood Cadmium Rate: $ _________

Lab5: Benzene Clearance Rate: $ _________

Lab 6: Urine Chromium Rate: $ __________

Lab 7: Chext X-Ray Rate: $ __________

Lab 8: Electrocardiogram (EKG) Rate: $ _______

1.3 Option Period 2

Test Panel “01” Rate: $______

Test Panel “02” Rate: $ ______

Test Panel “03” Rate: $ ______

Test Panel “04” Rate: $_______

Test Panel “05” Rate: $_______

Lab 1: Complete Blood Count (CBC) Rate: $________

Lab 2: Complete Metabolic Profile (CMP) Rate: $ _________

Lab 3: Blood Lead / ZPP Rate: $ __________

Lab 4: Blood Cadmium Rate: $ _________

Lab5: Benzene Clearance Rate: $ _________

Lab 6: Urine Chromium Rate: $ __________

Lab 7: Chext X-Ray Rate: $ __________

Lab 8: Electrocardiogram (EKG) Rate: $ _______

1.4 Option Period 3

Test Panel “01” Rate: $______

Test Panel “02” Rate: $ ______

Test Panel “03” Rate: $ ______

Test Panel “04” Rate: $_______

Test Panel “05” Rate: $_______

Lab 1: Complete Blood Count (CBC) Rate: $________

Lab 2: Complete Metabolic Profile (CMP) Rate: $ _________

Lab 3: Blood Lead / ZPP Rate: $ __________

Lab 4: Blood Cadmium Rate: $ _________

Lab5: Benzene Clearance Rate: $ _________

Lab 6: Urine Chromium Rate: $ __________

Lab 7: Chext X-Ray Rate: $ __________

Lab 8: Electrocardiogram (EKG) Rate: $ _______

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