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<br />
<br />NORTH CAROLINA STATEWIDE FAMILY PLANNING PROGRAM
<br />
<br />SLIDING FEE SCALE
<br />
<br />FAMILY SIZE
<br />
<br />Monthly Range
<br />Annual Range
<br />
<br />Monthly Range
<br />Annual Range
<br />
<br /> 7
<br />$ 1,326 - under
<br />$15,912 - under
<br />
<br />$ 1,327 - $ 1,591
<br />$15,912 - $19,092
<br />
<br /> 8
<br />$ 1,355 - under
<br />$16,260 - under
<br />
<br />$ 1,356 - $ 1,626
<br />$16,261 - $19,512
<br />
<br /> 9
<br />$ 1,385 - under
<br />$16,620 - under
<br />
<br />$ 1,386 - $ 1,662
<br />$16,621 - $19,944
<br />
<br /> 10
<br />$ 1,414 - under
<br />$16,968 - under
<br />
<br />$ 1,415 - $ 1,697
<br />$16,969 - $20,364
<br />
<br /> 11
<br />$ 1,444 - under
<br />$1713328 - under
<br />
<br />$ 1,445 - $ 1,733
<br />$17,329 - $20,796
<br />
<br /> 12
<br />
<br />$ 1,473 - under
<br />$17,676 - under
<br />
<br />$ 1,474 -$ 1,768
<br />$17,677 - $21,216
<br />
<br />Monthly Range $ 1,592 - $ 1,856 $ 1,627 - $ 1,897 $ 1,663 - $ 1,939 $ 1,698 - $ 1,980 $ 1,734 - $ 2,022
<br />Annual Range $19,093 - $22,272 $19,513 - $22,764 $19,945 ~ $23,268 $20,365 - $23,760 $20,797 - $24,264
<br />
<br />60%
<br />
<br />Monthly Range $ 1,857 - $ 2,121 $ 1,898 - $ 2,168 $ 1,940 - $ 2,216 $ 1,981 - $ 2,263 $ 2,023 - $ 2,311
<br />Annual Range $22,273 - $25,452 $22,765 - $26,016 $23,269 - $26,592 $23,761 - $27,156 $24,265 - $27,732
<br />
<br />80%
<br />
<br />Monthly Range $ 2,122 - $ 2,386 $ 2,169 - $ 2,439 $ 2,217 - $ 2,493 $ 2,264 - $ 2,546 $ 2,312 - $ 2,600
<br />Annual Range $25,453 - $28,632 $26,017 - $29,268 $26,593 - $29,916 $27,156 - $30,552 $27,733 - $31,200
<br />
<br />100% Monthly Range $ 2,387 - over
<br /> Annual Range $28,633 - over
<br />
<br />$ 2,440 - over
<br />$29,269 - over
<br />
<br />$ 2,494 - over
<br />$29,917 - over
<br />
<br />$ 2,547 - over
<br />$30,553 - over
<br />
<br />$ 2,601 - over
<br />$31,201 - over
<br />
<br />The dollar figures represent monthly and annual gross income.
<br />Family size refers to those who are supported by or dependent on that income.
<br />Patients who are certified for Medicaid or Title XX will receive free service.
<br />Those falling below Title XX income eligible but not certified will be assessed a nominal fee (15%) of full charges.
<br />A waiver of all family planning fees is applied to teenagers.
<br />
<br />$ 1,769 - $ 2,063
<br />$21,217 - $24,756
<br />
<br />$ 2,064 - $ 2,358
<br />$24,757 - $28,296
<br />
<br />$ 2,359 - $ 2,653
<br />$28,297 - $31,836
<br />
<br />$ 2,654 - over
<br />$31,837 - over
<br />
<br />FEES
<br />
<br />Discount Level
<br />
<br />Initial or Annual Visit
<br />
<br />Medical with Pelvic Visit
<br />
<br />Medical Without Pelvic Visit
<br />
<br />15% $ 8.00 $ 4.00 $ 2.00
<br />20% $11.00 $ 5.00 $ 3.00
<br />40% $21.00 $10.00 $ 5.00
<br />60% $32.00 $14.00 $ 8.00
<br />80Z $43.00 $19.00 $11.00
<br />100% $53.50 $24.00 $13.50
<br />
<br />
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