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DocuSign Envelope ID:06CEAA47-F11 F-421A-B8CE-390F42C61208 <br /> Pharmac Solutions <br /> Description Pricing <br /> Retail Pharmacies <br /> Brand AWP-11%+$4.25 dispensing fee <br /> Generic AWP-50%+$4.25 dispensing fee <br /> Mail Order <br /> Brand AWP-12%+$3.50 dispensing fee <br /> Generic AWP-50%+$3.50 dispensing fee <br /> Clinical Modeling <br /> Integration of Pharmacy Data Included <br /> Dynamic Calculation/Display in CareMc Included <br /> Pharmacy Interventions <br /> Certified Pharmacy Technician Included <br /> Rx Nurse Included <br /> Nurse Management Case Management hourly rate <br /> Pharmacy Review-Per Review $375.00 <br /> Cognitive Behavioral Therapy-Per Hour $250.00 <br /> Medication Review-Per Hour $250.00 <br /> Ancilla Benefit Mana ement Services <br /> Description Pricing <br /> Medical Imaging Services Varies by State and Diagnostic <br /> Independent Medical Exam See 2022 IME/Peer Fee Schedule <br /> Physical and Occupational Therapy Varies by State <br /> Durable Medical Equipment Varies by State and Equipment <br /> IME Peer Review-Per Hour See 2022 IME/Peer Fee Schedule <br /> Transportation Varies by State and Service <br /> Translation Varies by State and Service Level <br /> Medicare A.ent Re i ortin <br /> Description Pricing <br /> Set up and engagement Included <br /> Monthly Maintenance Included <br /> Quarterly Reporting Included <br /> The above pricing per claim is based on handling of all claims that occur and are reported during the agreement <br /> period. If life of contract pricing is selected, claims will be handled until closed or until the end of the agreement <br /> period, whichever comes first. If life of claim pricing is selected, claims will be handled until closed <br /> Any service not identified in this proposal will be provided at a later time. <br /> City of Everett,WA—CorVel EC Amendment 3 7-25-2022 <br />