Clinic Forms & Fees

Fee Schedule – 2018

Immunizations – Administration Charges

CPT Code
Service DescriptionCharges
Children with Insurance
90460Administration NO MAX$30
90461Administration additional antigen w/counseling$20
Uninsured or Under-insured Children
90460Administration (1 shot)$20
90461Administration (2 shots)$40
90461Administration (3 shots or more) MAX
$60
Adults with Insurance
90471Administration NO MAX$30
90473Oral/Intranasal$30
99080IHIS$5
Uninsured Adults
90471Administration (1 shot)$30
90472Administration (2 shots)$60
90472Administration (3 shots or more) MAX$90
90473Oral/Intranasal$30
99080IHIS$5