Laserfiche WebLink
WO~£K'S HLALTH S[CTION SLIDING FE£ SCALE <br />HO~TRL¥ GROSS lhCO~E <br />FOR USE l~ FK~]LY PLAK~G AND HCH PROGRA,~S <br /> <br />CABARRUS COUNTY HEALTH DEPARIMEN~E FAMILY PLA~%'NING PROG~%M <br /> <br />100~ OF FAglLY ZERO PAY <br />POVERTY SIZE <br /> <br />TWENTY PERCENT FORTY PERCENT SIXTY F£RCENT []GHTi' PERCENT FIll PAY <br />PAY PAY PAY PAY ~EG1N$ <br /> <br />5552 ] $0 TO S552 SSS3 TO $690 S69] TO $828 $829 TO S965 S966 TO Sl]02 51103 <br />$7~0 2 $0 TO $7&0 $7~1 TO $925 $q26 TO $1110 $1]]! TO $1295 $12q6 TO S1~79 51~80 <br />1928 3 $0 ~O I928 $92~ TO $1160 51161 TO $1393 $139l TO $1625 11626 TO $1856 5185~ <br />$1117 & $0 TO $1117 $1116 TO $1396 $1397 ~O 11675 $1676 TO $1q56 $1955 TO $2232 S2233 <br />$1305 5 $0 TO $1305 $1306 TO $]631 $1632 TO $1958 $1959 TO $2284 $2285 TO $2609 52610 <br />$1t93 6 $0 TO $1693 $1&~ TO 51867 $1&GB TO $22~0 $22~I ~o 526~3 52~1g TO S2~86 <br />$1~82 7 $O TO $1682 $1683 TO $2102 $2103 TO $2523 $252~ TO $2q~3 $29~ TO $3362 53363 <br />51B70 8 $O TO $1870 $1871 TO $2338 52339 TO $28OS $2806 TO $3273 $327~ TO $3739 $37~0 <br />$2058 9 $0 TO $2058 $2059 TO $2573 $257& TO $3088 $3089 TO $3b02 $3b03 TO $~1~6 $&117 <br /> <br />$22~7 I0 $0 TO $22~7 $22~8 TO $2808 $2809 TO $3370 $3)71 TO $3932 <br />$2~35 11 $0 TO $2~35 $2~36 TO $304~ $3095 TO $3653 $365~ TO $~261 $~262 TO $~869 <br />$2623 12 $0 TO $2623 $262~ TO $3279 $3280 TO $3935 $3936 TO $~591 $~592 TO $52~6 $52q7 <br /> <br />INSTRUCTIONS: AFTi~ DETEr~IINING SL]DING SCALE PAY CATEGORY, FIND DOLI~ A.'~Ob'NT OF CI~GE OK APPROPRIATE SCHEPULE. <br /> <br />NOTE: No ~GES ~L~Y BE ASSESSEb ~F PATIEKT 15 ~EDICA1D ELIGIBLE. <br /> <br />WOOTEN'S HF_ALTR S£Cl']ON <br />712191, <br /> <br />SCHEDULE OF PAIIENI (SELF-PAY OR PRIVATE PAY) CHARGES <br />WO~N'S PREVENIIVE HEALIH SERVICES (FAMILY PLANNING) <br /> <br />SERVICE 2~ PAY &0% PAY 60% PAY 80% PAY FULL PAY <br /> <br /> Complete Physical $ 18.75 <br /> (Initial or Annual) <br /> <br /> Extended Revisit $ 7.85 <br /> (RevisiC w/pelvic) <br /> Limited Revisit $ 4.40 <br /> (Revisit w/o pelvic) <br /> <br /> Natural Family Planning $ 8.00 <br /> (NFP Services) <br /> <br />~Norplant Insertion $ 93.20 <br />.Norplant Removal $ 25,00 <br />Norplant Removal/Reinsertion $113.20 <br /> <br /> 37.50 $ 56.25 S 75.00 S 93,75 <br /> 15.70 S 23.85 S 31.40 S 39.25 <br /> 8.80 $ 13.20 $ 17.60 $ 22.00 <br /> 16.00 S 2~.O0 $ 32.00 S 40.O0 <br /> <br />S186.&0 $279.60 $372.80 $&66.O0 <br />50.00 S 75.00 SLO0.OO S125.00 <br />$226,40 $339.60 S&52.80 5566.00 <br /> <br />01/01/92 <br /> <br /> <br />