A	B	C	D	E
1	Addendum 2 Revised Attachment A – Pricing Table
2	Proposers shall complete the table below. All rates must be all-inclusive, covering labor, materials,
3	equipment, travel, licenses, pharmaceuticals, administrative or collection fees, subcontracted
4	laboratory/radiology costs, and any other associated expenses.
5	If a service is not offered, indicate “N/A.”
7	Service	Unit of Measure	Proposed Rate ($)	Notes / Comments / Includes List all analytes included in the proposed panel unless otherwise defined. Include defined cutoff levels.	Turnaround Times
8	I. Pre-Employment and Job-Related Physical Exams
9	Pre-Employment / Non-DOT Physical	Per exam
10	DOT Physical (FMCSA Compliant)	Per exam
11	Return-to-Duty / HAZWOPER Physical	Per exam
12	Fit-for-Duty Physical / Re-Evaluation
13	Police POST Physical
14	Fire NFPA 1582 Physical
16	II. Drug and Alcohol Testing Services
17	5-Panel Urine Drug Test (Non-DOT)	Per test
18	7-Panel Urine Drug Test (Non-DOT) defined cutoff levels • Amphetamines • Barbiturates • Methamphetamines • Cocaine • PCP • THC • Opiates • Benzodiazepines	Per test
19	10-Panel Urine Drug Test (Non-DOT)	Per test
20	12-Panel Urine Drug Test (Non-DOT)	Per test
21	DOT Urine Drug Test	Per test
22	Oral Fluid Drug Test	Per test
23	Hair Follicle Drug Test	Per test
24	Breath Alcohol Test (DOT and Non-DOT)	Per test
25	Confirmation / GC-MS Testing	Per test
26	Random Selection Administration	Per draw / selection
27	Recollection / Retest Fee	Per test
28	After-Hours or Emergency Testing	Per test
29	No-Show / Late Cancellation Fee	Per incident
30	Other Drug/Alcohol Testing Fees (list individually)	Specify
34	III. Labortory Tests
35	CBC (Complete Blood Count)	Per test
36	CMP (Comprehensive Metabolic Panel)	Per test
37	Hemoglobin A1c	Per test
38	Lipid Panel	Per test
39	Quantiferon Gold (TB Blood Test)	Per test
40	Titers – Hep B, MMR, Varicella	Per test
41	Urinalysis	Per test
42	Blood Draw Fee	Per draw
43	Other Laboratory Fees (list individually)	Specify
47	IV. Immunizations and Vaccines
48	MMR (Measles, Mumps, Rubella)	Per injection
49	Varicella	Per injection
50	Hepatitis A	Per injection
51	Hepatitis B	Per injection
52	Twinrix (Hep A/B Combination)	Per injection
53	Tdap / Td (Tetanus, Diphtheria, Pertussis)	Per injection
54	Influenza	Per injection
55	Administration Fee (per injection visit)	Per visit
56	Other Immunization Fees (list individually)	Specify
60	V. Screenings and Functional Evaluations
61	TB Test (1-step / 2-step)	Per test

62	Audiogram (Pure Tone)	Per test
63	ECG (12-lead)	Per test
64	Chest X-ray (1 or 2 view)	Per test
65	Pulmonary Function Test (PFT)	Per test
66	Vision Exam (Snellen, Titmus, Ishihara)	Per test
67	N95 Respirator Clearance + Fit Test	Per test
68	Ergonomic Evaluation	Per hour / evaluation
69	Lifting Evaluation
70	- 20-50 pound loads
71	- 75-pound loads
72	- 100-pound loads
73	Functional Capacity Evaluation (FCE) - Comprehensive assessment for return-to-duty or fit-for-duty determination. Conducted by licensed PT/OT, includes detailed report.
74	Other Functional Fees (list individually)	Specify
78	VI. Administrative and Optional Services
79	Consortium Enrollment Fee	Per participant
80	Consortium Annual Fee	Per participant
81	MRO Administrative Fee (if billed separately)	Per test reviewed
82	Record Copy / Administrative Report	Per request
83	Wellness Screenings	Per event / person
84	Immunization Clinic	Per shot
85	Other Optional Services (list individually)	Specify
89	Certification: I hereby certify that the prices quoted above are complete and inclusive of all costs necessary to perform
90	the required services as specified in the RFP.
91	Authorized Representative Name: ____________________________
92	Title: ____________________________
93	Signature: ____________________________			Date: ____________________