Fee Schedule

Vaccine Fees

CPT
codes
Brand Name Vaccine Type Vaccine
Fee
90648 ActHIB Haemophilus Influenzae Type B (HIB) $30
90715 Adacel Tdap $58
90620 Bexero Meningococcal B $249
90700 Daptacel DTaP $40
90744 Engerix-B Hepatitis B 10mcg (age 0-19y) $34
90746 Engerix-B Hepatitis B 20mcg (age 20y+) $82
90682 Flublok Quadrivalent Influenza $74
90686 Fluzone Quadrivalent Influenza $24
90662 FluzoneHD High-Dose Quadrivalent Influenza $74
90651 Gardasil-9 Human papillomavirus (HPV) $324
90739 Heplisav-B Hepatitis B $162
90713 IPOL Poliovirus, inactivated (IPV) $50
90734 Menactra Meningococcal ACWY $171
90619 MenQuadfi Meningococcal ACWY $189
90707 MMR II Measles, Mumps & Rubella $109
90698 Pentacel DTaP-IPV-HIB $160
90732 Pneumovax-23 Pneumococcal polyvalent $159
90670 Prevnar13 Pneumococcal conjugate $277
90677 Prevnar20 Pneumococcal conjugate $305
90696 Quadracel DTaP, Polio $72
90680 RotaTeq Rotavirus $113
90750 Shingrix Zoster recombinant $222
90714 Tenivac Td $43
90621 Trumenba Meningococcal B $217
90636 Twinrix HAV-HBV $147
90633 Vaqta Hepatitis A 25u (age 0-18y) $43
90632 Vaqta Hepatitis A 50u (age 19y+) $95
90716 Varivax Varicella $193
  ADMINISTRATION FEE per VACCINE $30

 

Health Services Fees

DeBug Shampoo $15
DeBug Oil $10
Lead Testing $25
Hgb Testing $20
TB Skin Test $20

 

*All vaccine cost are subject to change depending on pharmaceutical prices. VFC or 317 fund vaccines are no cost for vaccines, but there will be a $20 Administration Fee per vaccine. Clients given vaccine paid by VFC or 317 funds will not be denied due to of inability to pay. All clients paying in full at the time of service for purchased vaccine are eligible for 20% discount of the total bill.