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OIV. OF MATERNAL AMD CH[[/) HEALTM SLIDING FEE SCAL~ <br />MONTh%Y CROSS INCOME <br />FOR USE IN F~MKLY PLANNING AND MCH CLINICS <br /> <br />kQQ% OF FARIL¥ ~ERQ PAY ~EH'~Y PERCENT <br />POVERTY SIZE PAY <br /> <br /> CABARRUS COUNTY HEALTH DEPARMTNET <br /> <br />FAMILY PLANE ; PROGRAM FEE SCALE - (GROSS INCOME) <br /> <br />FORTY ?ER~NT <br />PAY <br /> <br />SIXTY PERCENT EICMTY PERCENT ~ULL PAY <br />PAY PAY BEG [ NS <br /> <br />$568 t $0 TO $568 <br />$766 2 $0 TO $766 <br />$964 3 $0 TO $964 <br />$1163 4 $0 TO $1163 <br />$1361 5 $O TO $1361 <br />$1559 6 $0 TO $1559 <br />$1758 7 $0 TO $1758 <br />$1956 8 $0 TO $1956 <br />$2154 9 $0 TO $2154 <br />$2353 10 $0 TO $2353 <br />$2551 I1 $0 TO $2551 <br />$2749 12 $0 TO $2749 <br /> <br />$569 TO <br />$767 TO <br />$965 TO <br />;1164 TO <br />;1362 TO <br />;1560 TO <br />;1759 TO <br />;1957 TO <br />;2155 TO <br />;2354 TO <br />;2552 TO <br />;2750 TO <br /> <br />$709 $710 <br />$957 $958 <br />;1205 $1206 <br />;1453 $1454 <br />;17~1 $1702 <br />;1949 $1950 <br />;2197 $2198 <br />;2445 $2446 <br />;2693 $2694 <br />;2941 $2942 <br />;3189 $3190 <br />;3436 $3437 <br /> <br />TO $851 $852 TO $993 $994 TO <br />TO $1149 $1150 TO $1340 $1341 TO <br />TO $1446 $1447 TO $1687 $1688 TO <br />TO $1744 $1745 TO $2034 $2035 TO <br />TO $2041 $2042 TO $2381 $2382 TO <br />TO $2339 $2340 TO $2729 $2730 TO <br />TO $2636 $2637 TO $3076 $3077 TO <br />TO $2934 $2935 TO $3423 $3424 TO <br />TO $3231 $3232 TO $3770 $3771 TO <br />TO $3529 $3530 TO $4117 $4118 TO <br />TO $3826 - $3827 TO $4464 $4465 TO <br />TO $4124 $4125 TO $4811 $4812 TO <br /> <br />INSTRUCTIONS: AFTER DETERMINING SLIDING $CAI.~ PAY CATEGORY, FIND DOLLAR AMOUNT <br /> <br />NOTE: NO CHARGES MAY 8E ASSESSED IF PATIENT IS MEDICAID ELIGIBLE. IF YEARLY <br /> SCALE. A~NUALIZED MONTHLY INCOME FIGURES MAY NOT EQUAL THOSE ON ANNUAL <br /> <br />DIV. OF MCH <br />6/15/92 <br /> <br />;1134 <br />;1531 <br />;1927 <br />;2324 <br />;2721 <br />;3117 <br />;3514 <br />;3911 <br />;4307 <br />;4704 <br />;5101 <br />;5497 <br /> <br />OF CHARGE ON APPROPRIATE SCHEDULE. <br /> <br />INCO~ iS KNOWN, USE ANNUAL <br />SCAL~ OUE TO ROUNDING. <br /> <br /> S~ OF PATIENT (SELF-PAY OR PRIVATE PAY) Qt&RGES <br /> W~'S PROVE HEALTH SERVICES (FAMILY PLANNI~) <br /> <br /> S]5~VICE 20% PAY 40% PAY 60% PAY <br /> <br />O~plete Fhystc-~ $ 18.75 $ 37.50 $ 56.25 <br />(Inittal or Arm, t~l) <br />Extended Revisit $ 7.85 $ 15.70 $ 23.85 <br />(Revisit w/pelvic) <br />Llmitad Revisit $ 4.40 $ 8.80 $ 13.20 <br />(Revisit w/o pelvic) <br />Natural Family Planning $ 8.00 $ 16.00 $ 24.00 <br />(~? Services) <br /> <br />Norplan t Insertion $101.20 $202.40 $303.60 <br />Norplant Rmnoval $ 25.00 $ 50,00 $ 75.00 <br />Narplan t Removal/Rainser tion $121.20 $242.40 $363.60 <br /> <br />3-16-92: Approved by Board of Commissionser. <br />8-4-92: <br /> <br />$80% PAY <br /> <br />$ 75.00 <br />$ 31.40 <br />$ 17.60 <br />$ 32.00 <br /> <br />$4O4.8O <br />$100.00 <br />$484.8O <br /> <br />Approved by Pzmrd of Heal th and County Ommissioners 8-3-92. <br /> <br />;1135 <br />;1532 <br />; 1928 <br />;2325 <br />;2722 <br />;3118 <br />;3515 <br />;3912 <br />;4308 <br />;4705 <br />;5102 <br />;5498 <br /> <br />FLFLL PAY <br /> <br />$ 93.75 <br />$ 39.25 <br />$ 22.00 <br />$ 40.00 <br /> <br />$5O6 o00 <br />$125.00 <br />$606.00 <br /> <br /> <br />