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- Insurances will be billed and client will be responsible for whatever
portion is not covered by insurance.
- Administration Fees charged will be based on a sliding fee scale according to 150%
federal poverty guidelines.
- Each immunization will have an individual charge.
- If you do not have insurance coverage, we can provide you an application
to see if you qualify for Healthy Kids or MIChild.
- Charge to you helps covers the cost for administration of the
immunization, supplies needed to administer the immunization, costs involved
in billing insurances and clients, and general ancillary costs.
- PLEASE NOTE: The sliding scale
applies only to the
administration fee. If the child is not eligible for the VFC (Vaccines
for Children) program, the cost of the vaccine is billed to any private
insurance. If the child does not have private insurance, or if the
private insurance doesn't pay 100% of the vaccine cost, the client is
responsible for the balance of the cost of the vaccine.
|
SLIDING SCALE |
|
Family Size |
Yearly Income |
|
No Charge |
20% |
40% |
60% |
80% |
100% |
|
1 |
0 - 3248 |
3249 - 6497 |
6498 - 9746 |
9747 - 12995 |
12996 - 16244 |
16245+ |
|
2 |
0 - 4370 |
4371 - 8741 |
8742 - 13112 |
13113 - 17483 |
17484 -0 21854 |
21885+ |
|
3 |
0 - 5492 |
5493 - 10985 |
10986 - 16478 |
16479 - 21971 |
21972 - 27464 |
27465+ |
|
4 |
0 - 6614 |
6615 - 13229 |
13230 - 19844 |
19845 - 26459 |
26460 - 33074 |
33075+ |
|
5 |
0 - 7736 |
7737 - 15473 |
15474 - 23210 |
23211 - 30947 |
30948 - 38684 |
38685+ |
|
6 |
0 - 8858 |
8859 - 17717 |
17718 - 26576 |
26577 - 35435 |
35436 - 44294 |
44295+ |
|
7 |
0 - 9980 |
9981 - 19961 |
19962 - 29942 |
29943 - 39923 |
39924 - 49904 |
49905+ |
|
8 |
0 - 11102 |
11103 - 22205 |
22206 - 33308 |
33309 - 44411 |
44412 - 55514 |
55515+ |
Find the row with the number of people in your family, follow the row until
you find the range your yearly income falls into. At the top of that column is
the percentage of the charge that you will be responsible for. For example, a
family of 8, with a yearly income of $35,000, would be responsible for paying
60% of the administration fee, which is shown in the “Administration Fee” column in the
table below.
This model fee scale is effective February 16, 2002.
|
Total Cost of Vaccine and What You Will Be Paying |
|
Vaccine |
Vaccine Cost |
Administration Fee |
Vaccine |
Vaccine Cost |
Administration Fee |
| DtaP-Aventis |
$21.40 |
$8.00 |
HBV-Merck |
$ 9.00 |
$12.00 |
| DTaP-SKB |
$ 13.75 |
$8.00 |
HBV-SKB |
$ 9.50 |
$12.00 |
| DT-Aventis |
$ 7.10 |
$8.00 |
Varicella-Merck |
$52.29 |
$12.00 |
| Td-Aventis |
$ 10.51 |
$8.00 |
Prevnar-Lederle |
$65.20 |
$12.00 |
| Hib-Aventis |
$10.89 |
$8.00 |
Comvax |
$43.56 |
$12.00 |
| Hib-Merck |
$22.77 |
$8.00 |
MMR-Merck |
$38.05 |
$12.00 |
| IPV-Aventis |
$21.80 |
$8.00 |
DTaP-HepB-IPV |
$35.48 |
$12.00 |
Page Last Updated:
06/26/2009
 
  
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