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DocuSign Envelope 1D: A55F15CO-1E47-4E4E-AD3E-815FB09D12D8 <br />Additional Pricing <br />Concentra appreciates the opportunity to present our proposed fee schedule. We affirm all <br />information contained herein is current, complete, accurate, and remains valid for 180 days <br />following the date of our submittal Estimated # of tests based on T12 actual where <br />applicable <br />TB Test $39 168 <br />Urinalysis with microscopy (UA wlmicro) $29 86 <br />Urinalysis with dipstick (dipstick UA) $29 Unknown <br />Court Fee Proceedings <br />$250-00 per <br />Unknown <br />hour <br />Vision (Titmus) <br />$39 <br />Unknown <br />Vision (Ishihara 14 panel) <br />$23 <br />118 <br />Treadmill Stress Test <br />$150 <br />Unknown <br />Chem Panel 23 <br />$83 <br />86 <br />CBC wldiff <br />$55 <br />86 <br />Venipuncture <br />$35 <br />Unknown <br />Collection Fee <br />$23 <br />2 <br />Lipid Panel <br />$60 <br />86 <br />Physical PrePlacement <br />$84 <br />365 <br />Rapid 10 panel UDS <br />$95 <br />18 <br />Non Reg UDS 10 Panel <br />$75 <br />190 <br />Note regarding any applicable immunization services: After the first twelve months of an awarded and <br />executed contract, if the current market price for the above services change due to market conditions, <br />demand(s) and/or shortage(s), the City would be billed the then current market rate. <br />