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DIV. OF MATERNAL AND CHILD HEALTH SLIDING FEE SCALE <br />MONTHLY GROSS INCOME <br />FOR USE IN FAMILY PLANNING AND MCH PROGRAMS <br /> <br />CABARRUS COUNTY HEALTH DEPARTMENT FAMILY PLANNING PROGRAM <br />FAMILY PLANNING PROGRAM FEE SCALE - (GROSS INCOME) <br /> <br />(SAME AS MATERNAL HEALTH PROGRAM FEE SCALE - (GROSS INCOME) - Page 208) <br /> <br />DIV. of MCH <br />6/10/94 <br /> <br />SCHEDULE OF PATIENT (SELF-PAY OR PRIVATE PAY) CHARGES <br />WOMEN'S PREVENTIVE HEALTH SERVICES (FAMILY PLANNING) <br /> <br /> SERVICE <br />Initial Physical <br />Annual Physical <br />Extended Revisit <br /> (Revisit w/pelvic) <br />Limited Revisit <br />(Revisit w/o pelvic) <br />Natural Family Planning <br /> (NFP Services) <br />Norplant Insertion <br />Norplant Removal <br />Norplant Removal/Reinsertion <br />Depo Provera Injection <br /> <br />20% PAY 40% PAY 60% PAY <br /> <br />$ 27.28 $ 54.55 $ 81.83 <br />$ 17.56 $ 35.12 $ 52.68 <br />$ 14.83 $ 29.66 $ 44.48 <br /> <br />80% PAY FULL PAY <br /> <br />$109.10 $136.38 <br />$ 70.24 $ 87.80 <br />$ 59.31 $ 74.14 <br /> <br />$ 8.66 $ 17.31 $ 25.97 $ 34.62 $ 43.28 <br /> <br />$ 8.00 $ 16.00 $ 24.00 <br /> <br />$111.16 $222.32 $333.48 <br />$ 46.49 $ 92.99 $139.48 <br />$140.62 $281.24 $421.87 <br />$ 5.27 $ 10.54 $ 15.81 <br /> <br />$ 32.00 $ 40.00 <br /> <br />$444.64 $555.80 <br />$285.98 $232.47 <br />$562.49 $703.11 <br />$ 21.08 $ 26.35 <br /> <br />DIV. OF MATERNAL AND CHILD HEALTH SLIDING FEE SCALE <br />MONTHLY GROSS INCOME <br />CABARRUS COUNTY HEALTH DEPARTMENT FAMILY PLANNING PROGRAM <br />FOR USE IN FAMILY PLANNING AND MCH PROGRAMS <br /> <br />CABARRUS COUNTY HEALTH DEPARTMENT <br />ADULT WELLNESS PROGRAM FEE SCALE - (GROSS INCOME) <br /> <br />(SAME AS MATERNAL HEALTH PROGRAM FEE SCALE - (GROSS INCOME) - Page 208) <br /> <br />20% Pay 40% Pay 60% Pay 80% Pay Full Pay <br /> <br />$ 4.00 $ 8.00 $12.00 $16.00 $20.00 <br /> <br />***NO CHARGE FOR THOSE 65 YEARS OF AGE AND OVER. <br /> <br /> <br />