Exhibit A
San Mateo County Public Health Clinic Fee Schedule
Fee* | |
Hepatitis A |
$53.48 |
Hepatitis B – Recombivax |
$92.50 |
Hepatitis B – Engerix–B |
$59.23 |
Combined Hepatitis A/B (Twinrix) |
$75.38 |
Influenza |
$35.00 |
HPV Vaccine |
$161.76 |
Meningococcal Meningitis |
$130.96 |
Mumps, Measles, Rubella |
$82.01 |
Polio |
$61.92 |
Pneumococcal pnuemonia |
$71.03 |
Tetanus: Tdap |
$71.46 |
Tetanus: Td |
$51.71 |
Varicella |
$113.41 |
Shingles (Zostavax) |
$188.93 |
Skin Tests |
Fee* |
Tuberculosis skin testing |
$35.00 |
2-Step Tuberculosis skin testing |
$49.00 |
Blood Draws and PH Lab fees |
Fee* |
Mumps, Measles, Rubella immunity panel |
$85.00 |
Measles (only) immunity |
$50.00 |
Mumps (only) immunity |
$50.00 |
Rubella (only) immunity |
$50.00 |
Hepatitis B Infection Panel (HBsAg, HBsAb, HBcAB) |
$95.00 |
Hepatitis B Immunity (HBsAb only) |
$50.00 |
Varicella immunity |
$50.00 |
TB blood test (Quanterferon Gold) |
$75.00 |
Syphilis (EIA) |
$45.00 |
RPR Quantitative (Positive Syphilis) |
$5.00 |
TPPA Syphilis Confirmation |
$15.00 |
HCV (EIA) |
$53.00 |
Herpes (PCR) |
$115.00 |
Herpesvirus Type 1 (serology) |
$50.00 |
Herpesvirus Type 2 (serology) |
$55.00 |
Children (under 18) Vaccine |
Fee* |
Hepatitis A |
$35.00 |
Hepatitis B (Recombivax or Engerix B) |
$35.00 |
Combined Hepatitis A/B (Twinrix) |
$35.00 |
Influenza |
$35.00 |
HPV Vaccine |
$35.00 |
Meningococcal Meningitis |
$35.00 |
Mumps, Measles, Rubella |
$35.00 |
Polio |
$35.00 |
Pneumococcal pnuemonia |
$35.00 |
Tetanus: Tdap |
$35.00 |
Tetanus: Td |
$35.00 |
Varicella |
$35.00 |
Shingles (Zostavax) |
$35.00 |
Fee* | |
Clinic Visit |
$25.00 |
Fee* | |
Physical Exam |
$60.00 |
Note: No charge for health screenings, i.e. blood pressure checks, diabetes tests, pregnancy tests, WIC hemoglobin checks |
|
Note: Well/ACE Program members pay Program co-pay only |
|
*Fees may be waived for any person who meets the eligibility criteria under the Federal Health Care for the Homeless Program (HCH) and/or for persons clinically determined to be at risk for transmitting an STD to others.