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ATTACHMENT F — FEE SCHEDULE <br />1. VOLUNTARY PHYSICAL <br />Provide cost per employee for all requirements and items to be performed annually as outlined and defined in Section <br />2.2. The cost per person identified should be inclusive of all costs associated with the annual physical exam including <br />overhead, indirect costs, etc. <br />Voluntary Physical Cost: $ 645.00 Per Employee X 900 Employees = $ 580,500.00 <br />2. ADDITIONAL SERVICES <br />In addition to the voluntary physicals described above, the employee, at their discretion, may ask the successful <br />proposer to provide additional testing/services as outlined and defined in Section 2.3 during their voluntary exam. The cost <br />per person should be inclusive of all costs associated with the test/service including test result reviews, overhead, indirect <br />costs, etc. and will not be included in the cost scoring criteria. <br />1. Chest X -Ray <br />$ <br />87.00 <br />2. Respirator Fit Testing (SCBA Face piece Fit Test/N-95 Respirators <br />$ <br />57.00* <br />*Department to supply N-95 Masks <br />3. Hepatitis B Test (antigen) <br />$ <br />65.00 <br />4. Hepatitis B Test (antibody) <br />$ <br />65.00 <br />5. Hepatitis B Vaccine (3 per series) Hepatitis B=3 shot series Based on current market <br />costs <br />$ <br />82.00 per shot <br />6. Hepatitis A Test (antigen) <br />$ <br />65.00 <br />42.00 <br />7. Hepatitis A Titer (antibody) <br />$ <br />8. Hepatitis A Vaccine (2 per series) Hepatitis A=2 shot series <br />$ <br />82.00 per shot <br />Based on current market <br />costs <br />9. PPD Test <br />$ <br />24.00 <br />Life Extension Clinics, Inc. D/B/A Life Scan Wellness Centers <br />Company Name: <br />Authorized Signature: Date: <br />50 121 <br />