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Docu5ign Envelope ID: 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 />DMV Physical <br />$104 <br />Unknown <br />Electrocardiogram (EKG) <br />$68 <br />38 <br />Hepatitis "A" blood screen <br />$67 <br />Unknown <br />Hepatitis "B" blood screen <br />$67 <br />Unknown <br />Hepatitis B Surface Antigen 498SB <br />$63 <br />Unknown <br />Hepatitis "B" booster <br />$83 <br />Unknown <br />Hepatitis "B" titer <br />$65 <br />Unknown <br />Hepatitis "B" vaccine <br />$105/x3 <br />Per shot/set of 3 <br />Hepatitis "A" vaccine <br />$1451x2 <br />Per shot/set of 2 <br />Hepatitis "C" blood screen <br />$65 <br />Unknown <br />HIV blood screen <br />$86 <br />Unknown <br />Pulmonary Function Test (Spirometry) <br />$46 <br />87 <br />Respirator Fit Test <br />$53 <br />Unknown <br />Respirator Physical <br />$92 <br />Unknown <br />Respirator Questionnaire <br />$33 <br />Unknown <br />Blood Screens-7 Panel Drug Screen <br />N/A <br />NIA <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 />