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3 <br /> New Health Department Fees <br /> August 17, 2010 <br /> Vaccine Free from OCHD Medicaid Fee Current Proposed GPT <br /> State? cost Fee Fee <br /> er dose <br /> DT Pediatric VFC only 2g,g4 No Medicaid Fee None 38.00 90702 <br /> DTaP VFC only 20.80 No Medicaid Fee None 31.00 90700 <br /> Pediarix VFC only 54.75 72.63 None 91.00 90723 <br /> (DTaP, Hep B & <br /> Polio combo <br /> Pentacel VFC only 71.58 No Medicaid Fee None 95.00 90698 <br /> (DTaP, polio& Hib <br /> combo <br /> Kinrix( VFC only 35.59 No Medicaid Fee None 47.00 90696 <br /> DTaP/IPV combo <br /> Twinrix Adults with 43.15 89.50 None 112.00 90636 <br /> (Hep A/B Combo) high risk <br /> sexual <br /> behavior onl *" <br /> Hep B VFC only 16.01 No Medicaid Fee None 25.00 90744 <br /> Peds <br /> PedvaxHib vFC only 22.02 19.68 None 26.00 90647 <br /> Acthib No 16.57 21.00 None 26.00 90648 <br /> Hiberix No 16.01 21.00 None 26.00 90648 <br /> Cervarix VFG only 101.05 No Medicaid Fee None 141.00 90650 <br /> Menveo vFC only 102.66 101.65 None 122.00 90734 <br /> Novartis <br /> Rotarix) VFC only 99.19 No Medicaid Fee None 124.00 90681 <br /> Td VFC only& 17.99 19.25 None 25.00 90714 <br /> certain adults'"' <br /> MCHAT no 8.14 None 13.00 99420EP <br /> "''`refer to current eligibility guide from the NC Immunization Program <br /> VFC-Federal Vaccines for Children Program <br /> I <br /> C:\Documents and Settin s�mallison�L.ocal Settin s\Tem ora Intemet Files\OLK108\081710 Attachment New vaccine fees.doc I' <br /> 9 9 P ►Y <br />