Like Olivia, I used a private guide for St. Petersburg, and so had to obtain my own Visa through the Russian Consulate in SF. It can be expensive. The basic cost is $100 but I think I ended up paying close to $250 per visa which included charges to expedite them ( they were running 2 weeks behind their normal processing time so I had to pay to expedite it :mad: ). We also needed a "sponsor" (our private guide sent us the appropriate paperwork).
Things may have simplified in the past two years, but unless you are going to be out wandering around on your own, I would use a service like Red October. You will then be under their "Group Visa".
No vaccinations are required.