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Home My WebLink AboutAG 21-008 - KAISER PERMANENTERETURN TO: ��JW n ",la'n [ t�4 EXT: CQ CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: n_kA W1 0,V1 2. ORIGINATING STAFF PERSON: �, 61 e � �� EXT: '015 3 Z 3. DATE REQ. 4. M TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) ❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT ❑ HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION A C ONTRACT AMENDMENT (AG#): V -06$ ❑ INTERLOCAL ❑ OTlIER NAME OF CONTRACTOR: S --@.:i'maYlee *c' ADDRESS: 300 S Z fi TELEPHONEZ�lo �1 D 7 E-MAIL: K F- FAX: SIGNATURE NAME: 4m j TITLE 7. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AIUTHORIITTY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: D 8 �� 9 l l —1 COMPLETION DATE: 9. TOTAL COMPENSATION $ ��fjI%1 C.� S ILGCO (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE -ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) RF,IMRI JRSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ❑ YES ❑ NO IF YES, RETAINAGE: RETAINAGE AMOUNT: ❑ PURCHASING: PLEASE CHARGE TO: 10. DOCUMENT/CONTRACT REVIEW ❑ PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) ❑ LAW 11. COUNCIL APPROVAL (IF APPLICABLE) 12 CONTRACT SIGNATURE ROUTING PAID BY: ❑ CONTRACTOR ❑ CITY ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED INITIAL I DATE REVIEWED IN [TIAL / DATE. APPROVED SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE: SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE: ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D:� ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE (Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.) INITIAL / DATE SIGNED ❑ LAW DEPARTMENT ❑ SIGNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ❑ ASSIGNED AG# UMR ffirfjla� 1 /2020 KAISER PERMANENTE OCCUPATIONAL HEALTH PROGRAM EMPLOYER: City of Federal Way Guarantor Number: 2937266 THIS SERVICE AGREEMENT (this "Agreement") is entered into as of February 8, 2021 by and between City of Federal Way (Employer), and Kaiser Foundation Health Plan of Washington ("Kaiser Permanente"). 1. CUSTOMER INFORMATION Agreement Manager Name: Title: Address: City, State, Zip Code: Phone: Email Jean Stanley HR Manager 33325 8th Ave. S Federal Way, WA 98003 253-835-2532 jean.stanley@cityoffederalway.com 2. KAISER PERMANENTE OF WASHINGTON INFORMATION Kaiser Foundation Health Plan of Washington Attention: Occupational Health Email to: KPWA.healthatwork@kp.org Toll Free Phone: (866) 967-9675 Secure Fax: (206) 877-0749 3. SERVICE(S) 3.1 Customer agrees to pay the specified fees for the Services indicated in Exhibit A - Fee Schedule, see attached, in accordance with Section 3.2. Kaiser Permanente may modify Services and/or fees charged for Services from time to time effective upon thirty (30) days written notice to Customer. Unless Customer terminates the applicable Service or this Agreement, in writing, within thirty (30) days after receiving notice of a modification, Customer shall be deemed to have accepted any such modification(s). Notwithstanding the foregoing, the fees charged for Services may be increased based on increases in the actual cost of consumables and the fees set forth in Exhibit A — Fee Schedule shall be deemed amended accordingly. 3.2 Kaiser Permanente shall invoice the Customer including a detailed data report showing recent charges, amount paid, and outstanding balance for Services on a monthly basis and the Customer shall pay invoiced amount within ninety (90) days after receipt of invoice. Late payments may be subject to interest at a rate of 1.5% per month or the legal rate, if lower ("Late Payment Interest"). Kaiser Permanente I Occupational Health Program F 1, KAISER PERMANENTE : OCCUPATIONAL HEALTH PROGRAM lease make payments to: Kaiser Foundation Health Plan of Washington ATTN: Cash Desk P.O. Box 34581 Seattle, WA 98124-1581 3.3 Customer shall promptly notify Kaiser Permanente of any disputed amounts upon receipt of invoice, and such disputed amounts shall not be subject to Late Payment Interest, provided the Customer: (a) assists Kaiser Permanente in resolving the dispute; and (b) promptly pays amounts owing, if any, upon resolution of the dispute. 3.4 Customer will comply with applicable legal requirements in relation to this Agreement, including, without limitation, any legal requirements applicable to the referral of individuals to Kaiser Permanente for Services or the subsequent use of results reports, or other information provided to Customer by Kaiser Permanente. Customer understands that Kaiser Permanente may review medical records in connection with the provision of Services and releases Kaiser Permanente from all liability with respect thereto or arising therefrom. 4. HEALTH INFORMATION To the extent information provided to, accessed by or created by Kaiser Permanente constitutes Protected Health Information subject to the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, or health information otherwise subject to applicable federal and state health information privacy laws, Kaiser Permanente agrees to, and Customer acknowledges that Kaiser Permanente will, use and disclose such information only as permitted or required by those laws and any other applicable laws, rules, or Kaiser Permanente policies. S. TERM AND TERMINATION 5.1 The term of this Agreement shall commence five (5) business days after Kaiser Permanente receives a copy of the Customer's signed agreement and shall continue in effect until terminated as follows: (a) by either party without cause upon thirty (30) days - notice to the other party; (b) by Customer in accordance with Section 3.2; or (c) by the non -breaching party in the event the other party defaults in the performance of a material obligation in this Agreement, provided such default is not promptly cured or corrected after receipt of notice thereof from the non -breaching party, and the non - breaching party provides written notice of termination to the defaulting party. 5.2 Upon termination of this Agreement for any reason, any fees owed to Kaiser Permanente for Services performed prior to termination shall be paid by Customer to Kaiser Kaiser Permanente I Occupational Health Program tF ' KAISER PERMANEWEr OCCUPATIONAL HEALTH PROGRAM Permanente Washington within thirty (30) days after the effective date of such termination. 6. GOVERNING LAW This Agreement shall be governed and construed in accordance with the internal laws of the State of Washington without regard to its conflict of laws principles. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their duly authorized representatives as of the Effective Date. CUSTOMER: Printed Name: Jean Stanley Title: HR Manager Date Signed: Feb 8, 2021 KAISER PERMANENTE: By: 6A' - �-kda-7aYJ Printed Name: Patricia Isaman, RN, MN Title: Director, Occupational Health Date Signed: 2.8.21 i Kaiser Permanente I Occupational Health Program F 1, KAISER PERMANEIITL, OCCUPATIONAL HEALTH PROGRAM EXHIBITA - FEE SCHEDULE For all work -related injury care, Kaiser Permanente of Washington will bill at the Washington State Department of Labor and Industry's current fee schedule. Post-Accident/For Cause Drug Testing Non -Federal Drug Screening 10 panel $45.00 Federal Drug Screening $55.00 Tuberculosis Skin Test Tuberculosis (PPD) Skin Test $24.00 As Clinically Indicated: Quantiferon Gold Test $220.00 Blood Draw, Venipuncture $9.00 Tuberculosis Health Risk Assessment $40.00 Hepatits B Hepatitis B Vaccine - Only 1st►njection Authorized by Employer $65.00 Hepatitis B Antibody (Titer) $46.00 Immunization Admin $27.00 Blood Draw, Venipuncture $9.00 Interpretative Services Interpretative Services, per hour $75.00 Audiometry Screen Screening Test Pure Tone Air Only $36.00 Interpretive Services Interpretive Services, per hour $75.00 Kaiser Permanente I Occupational Health Program I I RETURN TO: � ew St `txi EXT: 95 3 a - CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: P I,i.man 2. ORIGINATING STAFF PERSON: EXT: O 5 3. DATE REQ. BY: 4. TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) ❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT ❑ HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL ❑ OTHER,J- 5. PROJECT NAME: e S C f Q aum(j'7 e n 4e C&Uw nh rr a�{ 6. NAME OF CONTRACTOR: M ADDRESS: 1300 $(4) 27447 j +w3 i )A C M651 TELEPHONE 24& $qz) cjo'f7 E-MAIL: Kaikl r.A. tanei La • 6+C6 FAX: SIGNATURE NAME: e, ►g .-na 7 Q N , N TITLE j� I rtGt } p EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: 080il a 1-1 COMPLETION DATE: P-t4. P _AjAI TOTAL COMPENSATION $ - I-T 5 .Sew ,td (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ❑ YES ❑ NO IF YES, $ RETAINAGE: RETAINAGE AMOUNT: ❑ PURCHASING: PLEASE CHARGE TO: 10. DOCUMENT/CONTRACT REVIEW ❑ PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) ❑ LAW 11. COUNCIL APPROVAL (IF APPLICABLE) 12. CONTRACT SIGNATURE ROUTING PAID BY: ❑ CONTRACTOR ❑ CITY ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED INITIAL / DATE REVIEWED INITIAL / DATE APPROVED SCHEDULED COMMITTEE DATE: COMMITTEE APPROVAL DATE: SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE: ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D:^ ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE (Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.) INITIAL / DATE SIGNER ❑ LAW DEPARTMENT _ oil A ❑ SIGNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ❑ ASSIGNED AG# AG# 'C]� COMMENTS: �� 1 /2020 FF'm'�, KAISER PERMANENTE, OCCUPATIONAL HEALTH PROGRAM EMPLOYER: City of Federal Way Guarantor Number: 2937266 THIS SERVICE AGREEMENT (this "Agreement") is entered into as of August 9, 2019 by and between City of Federal Way (Employer), and Kaiser Foundation Health Plan of Washington ("Kaiser Permanente"). 1. CUSTOMER INFORMATION Agreement Manager Name: Title: Address: City, State, Zip Code: Phone: Email Jean Stanley HR Manager 33325 8th Ave. S Federal Way, WA 98003 253-835-2532 jean.stanley@cityoffederalway.com 2. KAISER PERMANENTE OF WASHINGTON INFORMATION Kaiser Foundation Health Plan of Washington Attention: Occupational Health Email to: KPWA.healthatwork@kp.org Toll Free Phone: (866) 967-9675 Secure Fax: (206) 877-0749 3. SERVICE(S) 3.1 Customer agrees to pay the specified fees for the Services indicated in Exhibit A - Fee Schedule, see attached, in accordance with Section 3.2. Kaiser Permanente may modify Services and/or fees charged for Services from time to time effective upon thirty (30) days written notice to Customer. Unless Customer terminates the applicable Service or this Agreement, in writing, within thirty (30) days after receiving notice of a modification, Customer shall be deemed to have accepted any such modification(s). Notwithstanding the foregoing, the fees charged for Services may be increased based on increases in the actual cost of consumables and the fees set forth in Exhibit A — Fee Schedule shall be deemed amended accordingly. 3.2 Kaiser Permanente shall invoice the Customer including a detailed data report showing recent charges, amount paid, and outstanding balance for Services on a monthly basis and the Customer shall pay invoiced amount within ninety (90) days after receipt of invoice. Late payments may be subject to interest at a rate of 1.5% per month or the legal rate, if lower ("Late Payment Interest"). Kaiser Permanente I Occupational Health Program ,7S ••s KAISER PERMANEME.. OCCUPATIONAL HEALTH PROGRAM lease make payments to: Kaiser Foundation Health Plan of Washington ATTN: Cash Desk P.O. Box 34581 Seattle, WA 98124-1581 3.3 Customer shall promptly notify Kaiser Permanente of any disputed amounts upon receipt of invoice, and such disputed amounts shall not be subject to Late Payment Interest, provided the Customer: (a) assists Kaiser Permanente in resolving the dispute; and (b) promptly pays amounts owing, if any, upon resolution of the dispute. 3.4 Customer will comply with applicable legal requirements in relation to this Agreement, including, without limitation, any legal requirements applicable to the referral of individuals to Kaiser Permanente for Services or the subsequent use of results reports, or other information provided to Customer by Kaiser Permanente. Customer understands that Kaiser Permanente may review medical records in connection with the provision of Services and releases Kaiser Permanente from all liability with respect thereto or arising therefrom. 4. HEALTH INFORMATION To the extent information provided to, accessed by or created by Kaiser Permanente constitutes Protected Health Information subject to the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, or health information otherwise subject to applicable federal and state health information privacy laws, Kaiser Permanente agrees to, and Customer acknowledges that Kaiser Permanente will, use and disclose such information only as permitted or required by those laws and any other applicable laws, rules, or Kaiser Permanente policies. 5. TERM AND TERMINATION 5.1 The term of this Agreement shall commence five (5) business days after Kaiser Permanente receives a copy of the Customer's signed agreement and shall continue in effect until terminated as follows: (a) by either party without cause upon thirty (30) days - notice to the other party; (b) by Customer in accordance with Section 3.2; or (c) by the non -breaching party in the event the other party defaults in the performance of a material obligation in this Agreement, provided such default is not promptly cured or corrected after receipt of notice thereof from the non -breaching party, and the non - breaching party provides written notice of termination to the defaulting party. 5.2 Upon termination of this Agreement for any reason, any fees owed to Kaiser Permanente for Services performed prior to termination shall be paid by Customer to Kaiser Kaiser Permanente I Occupational Health Program '�'''� KAISER PERMANEW .: OCCUPATIONAL HEALTH PROGRAM Permanente Washington within thirty (30) days after the effective date of such termination. 6. GOVERNING LAW This Agreement shall be governed and construed in accordance with the internal laws of the State of Washington without regard to its conflict of laws principles. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their duly authorized representatives as of the Effective Date. CUSTOMER: �+ x*� Stanity (Feb 2,:e x"; "1 PS I Printed Name: Jean Stanley Title: HR Manager Date Signed: 0 2102` zo Zl KAISER PERMANENTE: : B �� y Printed Name: Patricia Isaman. RN, MN Title: Director, Occupational Health Date Signed: 1.29.2021 Kaiser Permanente Occupational Health Program KAISER PERMANEWE. OCCUPATIONAL HEALTH PROGRAM EXHIBIT A - FEE SCHEDULE For all work -related injury care, Kaiser Permanente of Washington will bill at the Washington State Department of Labor and Industry's current fee schedule. Post-Accident/For Cause Drug Testing Non -Federal Drug Screening 10 panel $45.00 Federal Drug Screening $55.00 Tuberculosis Skin Test Tuberculosis (PPD) Skin Test $24.00 As Clinically Indicated: Quantiferon Gold Test $220.00 Blood Draw, Venipuncture $9.00 Tuberculosis Health Risk Assessment $40.00 Hepatits B Hepatitis B Vaccine -Only 1stlnjection Authorized by Employer $65.00 Hepatitis B Antibody (Titer) $46.00 Immunization Admin $27.00 Blood Draw, Venipuncture $9.00 Interpretative Services Interpretative Services, per hour $75.00 Audiometry Screen Screening Test Pure Tone Air Only $36.00 As Clinically Indicated Tympanometry (Impedance Testing) $45.00 Comprehensive Audiometry Threshold Eval & Speech R $118.00 Interpretive Services Interpretive Services, per hour $75.00 Kaiser Permanente I Occupational Health Program f "ZI KAISER PFRMANEUTEO OCCUPATIONAL HEALTH PROGRAM EMPLOYER: Guarantor Number: City of Federal Way THIS SERVICE AGREEMENT (this "Agreement") is entered into as of August 9, 2019 by and between City of Federal Way (Employer), and Kaiser Foundation Health Plan of Washington ("Kaiser Permanente"). 1. CUSTOMER INFORMATION Agreement Manager Name.: Title: Address: City, State, Zip Code: Phone: Email Jean Stanley HR Manager 33325 8th Ave. S Federal Way, WA 98003 253-835-2532 jean.stanley@cityoffederalway.com 2. KAISER PERMANENTE OF WASHINGTON INFORMATION Kaiser Foundation Health Plan of Washington Attention: Occupational Health Email to: KPWA.healthatwork@kp.org Toll Free Phone: (866) 967-9675 Secure Fax: (206) 877-0749 3. SERVICE(S) 3.1 Customer agrees to pay the specified fees for the Services indicated in Exhibit A - Fee Schedule, see attached, in accordance with Section 3.2. Kaiser Permanente may modify Services and/or fees charged for Services from time to time effective upon thirty (30) days written notice to Customer. Unless Customer terminates the applicable Service or this Agreement, in writing, within thirty (30) days after receiving notice of a modification, Customer shall be deemed to have accepted any such modification(s). Notwithstanding the foregoing, the fees charged for Services may be increased based on increases in the actual cost of consumables and the fees set forth in Exhibit A — Fee Schedule shall be deemed amended accordingly. 3.2 Kaiser Permanente shall invoice the Customer including a detailed data report showing recent charges, amount paid, and outstanding balance for Services on a monthly basis and the Customer shall pay invoiced amount within ninety (90) days after receipt of invoice. Late payments may be subject to interest at a rate of 1.5% per month or the legal rate, if lower ("Late Payment Interest"). Kaiser Permanente I Occupational Health Program } KAISER PERMANENTEo OCCUPATIONAL HEALTH PROGRAM lease make payments to: Kaiser Foundation Health Plan of Washington ATTN: Cash Desk P.O. Box 34581 Seattle, WA 98124-1581 3.3 Customer shall promptly notify Kaiser Permanente of any disputed amounts upon receipt of invoice, and such disputed amounts shall not be subject to Late Payment Interest, provided the Customer: (a) assists Kaiser Permanente in resolving the dispute; and (b) promptly pays amounts owing, if any, upon resolution of the dispute. 3.4 Customer will comply with applicable legal requirements in relation to this Agreement, including, without limitation, any legal requirements applicable to the referral of individuals to Kaiser Permanente for Services or the subsequent use of results reports, or other information provided to Customer by Kaiser Permanente. Customer understands that Kaiser Permanente may review medical records in connection with the provision of Services and releases Kaiser Permanente from all liability with respect thereto or arising therefrom. 4. HEALTH INFORMATION To the extent information provided to, accessed by or created by Kaiser Permanente constitutes Protected Health Information subject to the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, or health information otherwise subject to applicable federal and state health information privacy laws, Kaiser Permanente agrees to, and Customer acknowledges that Kaiser Permanente will, use and disclose such information only as permitted or required by those laws and any other applicable laws, rules, or Kaiser Permanente policies. 5. TERM AND TERMINATION 5.1 The term of this Agreement shall commence five (5) business days after Kaiser Permanente receives a copy of the Customer's signed agreement and shall continue in effect until terminated as follows: (a) by either party without cause upon thirty (30) days - notice to the other party; (b) by Customer in accordance with Section 3.2; or (c) by the non -breaching party in the event the other party defaults in the performance of a material obligation in this Agreement, provided such default is not promptly cured or corrected after receipt of notice thereof from the non -breaching party, and the non - breaching party provides written notice of termination to the defaulting party. 5.2 Upon termination of this Agreement for any reason, any fees owed to Kaiser Permanente for Services performed prior to termination shall be paid by Customer to Kaiser Permanente Washington within thirty (30) days after the effective date of such termination. Kaiser Permanente I Occupational Health ProgramY A KAISER PERMANEWEr- OCCUPATIONAL HEALTH PROGRAM 6. GOVERNING LAW This Agreement shall be governed and construed in accordance with the internal laws of the State of Washington without regard to its conflict of laws principles. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their duly authorized representatives as of the Effective Date. CUSTOMER: Printed Name: Jean Stanley Title: HR Manager KAISER PERMANENTE: By: I Printed Name: Patricia Isaman, RN. MN Title: Director, Occupational Health Date Signed: Q Z �4/�} Date Signed 8/9/2019 Kaiser Permanente I Occupational Health Program F- '1 KAISER PERMANEWEe OCCUPATIONAL HEALTH PROGRAM EXHIBIT A - FEE SCHEDULE For all work -related injury care, Kaiser Permanente of Washington will bill at the Washington State Department of Labor and Industry's current fee schedule. Post-Accident/For Cause Drug Testing Non -Federal Drug Screening 10 panel - Ens50G $45.00 Federal Drug Screening $55.00 Tuberculosis Skin Test Tuberculosis (PPD) Skin Test $24.00 Ancillary Quantiferon Gold Test $220.00 Blood Draw, Venipuncture $9.00 Tuberculosis Health Risk Assessment $40.00 Hepatits B Hepatitis B Vaccine - Only 1selnjection Authorized by Employer $65.00 Hepatitis B Antibody (Titer) $46.00 Immunization Admin $27.00 Blood Draw, Venipuncture $9.00 Interpretative Services Interpretative Services, per hour $75.00 Kaiser Permanente I Occupational Health Program :;