| Private Vaccine Fee Schedule |
| |
| Vaccine: |
Fee: |
| DTaP (Pediatric) |
$ 43.00 |
| DTaP, Polio (Pediatric) |
$ 73.00 |
| DTaP, IPV, Hep B (Pediatric) |
$ 91.00 |
| Hepatitis A (Pediatric) |
$ 49.00 |
| Hepatitis A & B (Adult) |
$ 101.00 |
| Hepatitis A (Adult) |
$ 63.00 |
| Hepatitis B (Adult) Engerix-B |
$ 67.00 |
| Hepatitis B (Adult) Heplisav-B |
$ 125.00 |
| Hepatitis B (Pediatric) |
$ 40.00 |
| Haemophilus Influenza |
$ 33.00 |
| Human Papillomavirus (HPV) |
$ 224.00 |
| Japanese Encephalitis |
Special Order |
| Meningococcal Group A, C, Y, W-135 |
$ 127.00 |
| Meningococcal Group B |
$ 170.00 |
| MMR |
$ 92.00 |
| Pneumococcal Conjugate (PCV 13) |
$ 203.00 |
| Pneumonia (23) |
$ 107.00 |
| Polio |
$ 53.00 |
| Rabies |
$ 333.00 |
| Rotavirus (Pediatric) |
$ 104.00 |
| Shingles (Adult) |
$ 162.00 |
| Tdap |
$ 59.00 |
| Tetanus/Diptheria |
$ 51.00 |
| Typhoid |
$ 118.00 |
| Varicella |
$ 143.00 |
| |
| Administration Fee - Vaccines for Children (VFC) Program & 317 Funded Vaccines $10.00 |
| *If client cannot pay, administration fee is waived. |
| * VFC vaccine can only be administered to children from birth through 18 years of age and who meet at least one of the following criterias: 1) Medi-Cal Eligible, 2) Uninsured, 3) American Indian & Alaskan Native |
| * Vaccines covered under the VFC Program includes: Dtap/Dt, Hepatitis A, Hepatitis B, Hib, HPV, Influenza, Meningococcal Conjugate, MMR, Pneumococcal Conjugate, Polio (IPV), Rotavirus, Td, Tdap, and Varicella (some of these vaccines may be available as combination vaccines: Kinrix (Dtap/Polio), Pediarix (Dtap/Polio/Hep. B), and Pentacel (Dtap/Polio, Hib) ) |
| * State general funded influenza vaccines can be administered to children and adults of all ages. |
| * Uninsured and Underinsured Adults (19 years of age and older) are eligible for the following 317 funded vaccines: Hepatitis A, Hepatitis B, HPV, Meningococcal Conjugate, MMR, Pnuemococcal Conjugate, Td (Only when Tdap is not inidcated), Tdap, Varicella, and Shingles. *Underinsured Adults are eligible only if listed vaccines are not covered by insurance. |
| Revised 09/06/2018 |
