Self-Pay and Out-of-Network Discounted Fee Schedule

PLEASE READ: The discounted “out-of-network” rates listed below are available for families who alert Hirsch Pediatrics of their insurance status BEFORE the appointment. Families who present insurance at the appointment that is later found to be terminated on the date of appointment are not eligible for a retroactive discount. Therefore, to receive the discounted fee schedule if you are out-of-network, you must notify us BEFORE the appointment.

** Note: Children who are uninsured may be eligible to receive all vaccines at no charge through the Montgomery County Health Department. Please call our office for more details.

** Discounted rates below will be adjusted periodically to reflect current pricing (last updated 10/2022). 

To help families anticipate out-of-pocket expenses, Hirsch Pediatrics includes ALL additional labs tests, procedures, and screening tests in the sick and well child visit fees. Note: The ONLY additional cost is for the vaccines. Please see below for vaccine expenses. 

Fee Schedule
Sick Visit $125
Well Child Exam $250

Individual Vaccine Costs


Vaccine Self-pay/Out-of-network insurance
Pentacel (DTaP/Hib/Polio) $165
Hepatitis B $40
Pneumococcal $354
Rotateq $140
MMR $135
Hepatitis A $56
DTaP $42
Hib $18
Varivax $235
Polio $44
Proquad (MMR/Varivax) $389
Quadracel (DTaP/Polio) $86
Tdap $66
Meningitis ACWY $187
Gardasil $337
Flu $55
COVID-19 $125

Well Child Exam Total Fee Including Vaccines

Age Additional vaccines usually done at appointment Self-pay/Out-of-network insurance total cost
Newborn first check-up None $250
2 Week None $250
1 Month None $250
2 Month Pentacel (DTaP/Polio/Hib), Hepatitis B, Pneumococcal, Rotateq $949
4 Month Pentacel (DTaP/Polio/Hib), Pneumococcal, Rotateq $909
6 Month Pentacel (DTaP/Polio/Hib), Hepatitis B, Pneumococcal, Rotateq $894
9 Month None $250
12 Month MMR, Prevnar, Hepatitis A $795
15 Month DTaP, Hib, Varivax $545
18 Month Hepatitis A $306
24 Month None $250
3 Year None $250
4 Year Quadracel (DTaP/Polio), Proquad (MMR/Varivax) $725
5-10 Year None $250
11 Year Tdap, Meningitis ACWY, Gardasil* $840
12-15 Year None $250
16 Year Meningitis ACWY $437
17-21 Year None $250

* Note: Gardasil vaccine given at age 11 requires one additional dose.