1582, LLC Exhibit B Pricing Matrix
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Panel A Panel B Panel C Panel D Panel E Panel F Panel G Panel H Panel I Candidate Annual Male Age 50 + Annual Female Age 50 + Male Age Under 40 At least every 3rd yr Female Age Under 40 At least every 3rd yr Male Age 40-49 Female Age 40-49 Male Age Under 40 Years 2 and 3 Female Age Under 40 Years 2 and 3 Laboratory Blood / Urine Testing: Complete Blood Count w/ Differential Comprehensive Metabolic Panel Fasting Lipid Panel Urinalysis (with Micro if indicated) 44.84 $ 44.84 $ 44.84 $ 44.84 $ 44.84 $ 44.84 $ 44.84 $ Hepatitis B Surface Antibody Blood Screening 19.40 $ Hepatitis C Antibody Blood Screening 27.16 $ Prostate Specific Antigen Blood Screening 24.25 $ PPD TB Skin Test 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ Audiogram 24.25 $ 24.25 $ 24.25 $ 24.25 $ 24.25 $ 24.25 $ 24.25 $ 24.25 $ 24.25 $ Spirometry 36.86 $ 36.86 $ 36.86 $ 36.86 $ 36.86 $ 36.86 $ 36.86 $ 36.86 $ 36.86 $ Vision Test (Snellen) Included Included Included Included Included Included Included Included Included Blood Pressure Monitoring Included Included Included Included Included Included Included Included Included 2 View Chest X-ray (with Radiology Overread) 38.80 $ Resting EKG 38.80 $ 38.80 $ 38.80 $ 38.80 $ 38.80 $ 38.80 $ 38.80 $ Medical History Review 30.00 $ Included Included Included Included Included Included Included Included Health Promotion Counseling Included Included Included Included Included Included Included Included Included Sleep Disturbance Apnea Questionnaire 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ Cardiac Risk Stratification 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ Mental Health Screening 20.00 $ 20.00 $ 20.00 $ 20.00 $ 20.00 $ 20.00 $ 20.00 $ 20.00 $ 20.00 $ OSHA Respirator Questionnaire and Clearance Letter 9.70 $ 9.70 $ 9.70 $ 9.70 $ 9.70 $ 9.70 $ 9.70 $ 9.70 $ 9.70 $ Physician Exam - (Chapter 7 Baseline / Annual) 154.27 $ 154.27 $ 154.27 $ 154.27 $ 154.27 $ 154.27 $ 154.27 $ 154.27 $ 154.27 $ 1582 MEDICAL EVALUTION PANEL PRICES 469.08 $ 377.97 $ 353.72 $ 353.72 $ 353.72 $ 353.72 $ 353.72 $ 270.08 $ 270.08 $ Chapter 8 - Annual Occupational Fitness Evaluation of Members 8.2.1 (Page 21) - A mandatory fitness evaluation that is not punitive or competitive shall be conducted annually as part of an individualized program Chapter 8 - Fitness Evaluation Panel A Panel B Panel C Panel D Panel E Panel F Panel G Panel H Panel I Chapter 8 - Muscular Strength, Endurance & Flexibility 90.00 $ 90.00 $ 90.00 $ 90.00 $ 90.00 $ 90.00 $ 90.00 $ 90.00 $ 90.00 $ Stress EKG, WFI Protocol (Chapter 8.2.2.1 - An evaluation of aerobic capacity shall be performed after appropriate medical evaluation) 72.75 $ 72.75 $ 72.75 $ 72.75 $ 72.75 $ 72.75 $ 72.75 $ 72.75 $ 72.75 $ 1582 FITNESS EVALUATION PANEL PRICES 162.75 $ 162.75 $ 162.75 $ 162.75 $ 162.75 $ 162.75 $ 162.75 $ 162.75 $ 162.75 $ Panel A Panel B Panel C Panel D Panel E Panel F Panel G Panel H Panel I TOTAL COST OF 1582 MEDICAL AND FITNESS PANELS 631.83 $ 540.72 $ 516.47 $ 516.47 $ 516.47 $ 516.47 $ 516.47 $ 432.83 $ 432.83 $ *Disclaimer: This is the interpreation of the 2018 edition of NFPA 1582, prepared by the team at 1582, Medical Director - Mark Gaetke, MD and Troy Ross, MD © 2019 - 1582, LLC The Firefighter Physical NFPA 1582 Panels - 2018 Edition* (interpreted by 1582 - Mark Gaetke, MD & Troy Ross, MD) Exhibit B ****ON-SITE MOBILE MEDICAL UNIT FEE IS AN ADDITIONAL $125.00 PER MEMBER**** Panel A Panel B Panel C Panel D Panel E Panel F Panel G Panel H Panel I Candidate Annual Male Age 50 + Annual Female Age 50 + Male Age Under 40 At least every 3rd yr Female Age Under 40 At least every 3rd yr Male Age 40-49 Female Age 40-49 Male Age Under 40 Years 2 and 3 Female Age Under 40 Years 2 and 3 HIV Screening 43.65 $ 43.65 $ 43.65 $ 43.65 $ 43.65 $ 43.65 $ 43.65 $ 43.65 $ 43.65 $ Heavy Metals Urine (Mercury, Lead, Arsenic, Cadmium) 125.00 $ 125.00 $ 125.00 $ 125.00 $ 125.00 $ 125.00 $ 125.00 $ 125.00 $ 125.00 $ 2 View Chest X-ray with Radiology Overread 38.80 $ 38.80 $ 38.80 $ 38.80 $ 38.80 $ 38.80 $ 38.80 $ Prostate Specific Antigen (010322) - Age 50 or Age 40 if Afr.Am. 24.25 $ 24.25 $ 24.25 $ Fecal Occult Blood - (offered at age 40 to 49 only) 98.35 $ 98.35 $ Quantiferon TB test - Upgrade 75.15 $ 75.15 $ 75.15 $ 75.15 $ 75.15 $ 75.15 $ 75.15 $ 75.15 $ 75.15 $ Respirator Fit Test (Quantitative) 30.00 $ 30.00 $ 30.00 $ 30.00 $ 30.00 $ 30.00 $ 30.00 $ 30.00 $ 30.00 $ Ultrasound Screening (Carotid, Thyroid, Aorta) 125.00 $ 125.00 $ 125.00 $ 125.00 $ 125.00 $ 125.00 $ 125.00 $ 125.00 $ 125.00 $ CDL Paperwork 45.00 $ 45.00 $ 45.00 $ 45.00 $ 45.00 $ 45.00 $ 45.00 $ 45.00 $ 45.00 $ Panel A Panel B Panel C Panel D Panel E Panel F Panel G Panel H Panel I Candidate Annual Male Age 50 + Annual Female Age 50 + Male Age Under 40 At least every 3rd yr Female Age Under 40 At least every 3rd yr Male Age 40-49 Female Age 40-49 Male Age Under 40 Years 2 and 3 Female Age Under 40 Years 2 and 3 MMR antibody Price Pending Tetanus antibody Price Pending Polio antibody Price Pending Varicella antibody Price Pending Influenza antibody Price Pending HPV testing Price Pending Tdap Vaccination 41.25 $ Polio Vaccination 125.50 $ Hepatitis A Vaccination 72.75 $ Hepatitis B Vaccination 58.20 $ Twinrix Vaccination 100.88 $ Varicella Vaccination 116.60 $ Influenza Vaccination 25.00 $ Panel A Panel B Panel C Panel D Panel E Panel F Panel G Panel H Panel I Candidate Annual Male Age 50 + Annual Female Age 50 + Male Age Under 40 At least every 3rd yr Female Age Under 40 At least every 3rd yr Male Age 40-49 Female Age 40-49 Male Age Under 40 Years 2 and 3 Female Age Under 40 Years 2 and 3 Mammography (every 2 yrs at 40, annually at age 50) Recommended Recommended Colonoscopy (age 50, unless indicated earlier) Recommended Recommended Gyn exam with Pap Smear (every 3 yrs or every 5 yrs w/ HPV testing) Recommended Recommended Recommended Recommended Recommended Urology evaluation (if positive for hematuria) Recommended Recommended Recommended Recommended Recommended Recommended Recommended Recommended Recommended *Disclaimer: This is the interpreation of the 2018 edition of NFPA 1582, prepared by the team at 1582, Medical Director - Mark Gaetke, MD and Troy Ross, MD © 2019 - 1582, LLC INFECTIOUS DISEASE MANGEMENT SUGGEST REFERRALS BY NFPA 1582 OPTIONAL ITEMS