CCHCS CLINIC FEES
RECORD RELEASES-ALL CLINICS
Proper Authorization to release information from the patient is ALWAYS required!!!
1) Duplicate Immunizations shot records must be approved by a supervisor or designee
2) All clinics’ duplicate record/chart requests are time sensitive and must be tracked before they are released
3)
See Healthcare Coordinator, Healthcare Administrator, or designee for protocol
Continuity of Care Requests (i.e. a doctor’s office requesting a record with proper/complete patient release of
information form) are provided at no charge
$0.00
Paper Record Request (1-20 pages) $5 Paper Record Request (21+ pages)
$5 + $.50 for each
page over 20*
EMPLOYEE HEALTH CLINIC
Sick Visit-State Employee Co-Pay
$20
Well Women Clinic-State Employee Co-Pay
$20
IMMUNIZATION CLINIC
All Vaccine Prices Subject to Availability
Public Health Visit – Immunizations
$0.00
Public Health Emergency Vaccines (JYNNEOS, etc.)
$0.00
PRIVATE PAY (PP)
Price
DTaP CHILD
$40
Influenza (Medicare Eligible) –need
insurance card and all info for billing ADULT
$0.00
DTaP - HepB – IPV (Pediarix) CHILD
$90
DTaP – Hib – IPV (Pentacel) CHILD
$150
IPV CHILD / ADULT
$65
DTaP - IPV (Kinrix) CHILD
$65
Meningitis CHILD / ADULT
$175
Haemophilus influenza type b (Hib) CHILD
$40
MMR CHILD / ADULT
$150
Hepatitis A (2 dose series) ADULT
$90
Pneumococcal Conjugate (PCV15) CHILD
$250
Hepatitis A (2 dose series) CHILD
$65
Pneumococcal (PCV20) ADULT
$250
Hepatitis B (3 dose series) ADULT
$90
Pneumococcal (PPV23) CHILD / ADULT
$125
Hepatitis B (3 dose series) CHILD
$65
Tdap CHILD / ADULT
$65
Immune Globulin (per vial) CHILD / ADULT
$600
Tetanus – diphtheria (Td) CHILD / ADULT
$40
Influenza (Non Medicare Eligible) ADULT
$40
Twinrix (Hep A & B)(3 dose series) ADULT
$125
Influenza CHILD
$40
Varicella (Chickenpox) CHILD / ADULT
$200
ADULT SAFETY NET (ASN)
Price
COVID-19
$0
Pneumococcal (PPSV23)
$20
Hepatitis A
$20
Shingles*
$20
Hepatitis B (3 dose series)
$20
Td
$20
HPV (3 dose series)
$20
Tdap
$20
Influenza (Inactive DSHS Program)
$10
Twinrix (3 dose series)*
$20
Meningitis (MCV4)
$20
Varicella
$20
MMR
$20
< 18 YEARS OF AGE IMMUNIZATION FEE SCHEDULE – VFC ADMINISTRATION FEES
Annual Income
Monthly Income
Administration Fee
$0 - $16,020
$0.0-$1,335
$0.00
$16,021 - $24,300
$1,336-$2,025
$5
$24,301 - $32,580
$2,026-$2715
$10
$32,581 +
$2,716 +
$13
STD CLINIC (Patients will not be refused STD services due to inability to pay)
Office visit -- STD (HIV, Syphilis, Chlamydia,
Gonorrhea, Female only: Trichomonas and Yeast)
$30 HPV Lesions (any quantity) $30
Public Health Visit --- STD Clinic
$0.00
I-693 Visit for STD Clinic (Immigration)
$200
Herpes Lab Work
$100
HIV Lab Fee – 24 hr results
$30
Hepatitis Profile – 24 hr results
$100
RPR Lab Fee – 24 hr results
$30
TB Clinic
New Office Visit Fee
$80
I-693 Office Visit
$200
LTBI Follow-Up Visit (includes meds/labs)
$0.00
IGRA (T-Spot)
$150
Public Health Visit-TB Clinic
$0.00
TST (< 5 yrs and/or clinician’s request only)
$75
DOT Visit (Public Health Visit)
$0.00
TB CASES, TB SUSPECT, & CONTACTS TO A TB CASE / SUSPECT ARE NOT CHARGED FOR ANY TB CLINIC SERIVCE. PATIENTS
WILL NOT BE REFUSED TB SERVICES DUE TO INABILITY TO PAY!
*This fee will be rounded down to the nearest dollar. Updated 10/3/2023