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Pre-Authorize Payment

Request Summary

Medical provider review and platform fees $49.99
COVID-19 Active Infection Swab Test (Lab will bill you directly)$100.00*
Estimated Total Cost:$149.99
Total Due Now:$49.99

* Estimated Patient Pay at Lab fees. Quest Diagnostics will bill you or your insurance company directly for the estimated lab fees of $100.00. Updated as of 9/24/21. Quest Diagnostics Patient Pay at Lab price not guaranteed by Push Health. Not an insurance co‐payment. Insurance may be accepted by Quest for these fees. Push Health not responsible for insurance billing.

Complete the form below to submit your request. All fields are required.

1. Choose Testing Location

Enter your Zip Code or city to see a list of available Quest Diagnostics lab locations in your area.

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Your Selected Lab

All Drive thru testing is by appointment only. Once your lab order request is approved, the link to the appointment scheduling will be available in your My Chart next to your lab order.

2. Patient Demographic Information

3. Patient Health Information

4. Confirm Request and Agree to Terms

Total due now: $49.99

Total due now includes the medical provider review and platform fees only. By clicking "Submit Request", you indicate that you, as the patient or legal guardian of the patient, agree:

  1. to follow up with my regular medical provider for ongoing care;
  2. to the best of my knowledge, all information submitted is accurate;
  3. to the Terms of Service and Consent to Telehealth.
  4. I understand that the total due now does not include any lab fees and that I am responsible for any fees billed by the lab.