Laserfiche WebLink
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 />100% OF FAMILY ZERO PAY TWENTY PERCENT FORTY PERCENT SIXTY PERCENT EIGHTY PERCENT FULL PAY <br />POVERTY SIZE PAY PAY PAY PAY PAY BEGINS <br /> <br /> $581 1 $0 to $581 $582 to $726 $727 to $871. $872 to $1016 $1017 to $1161 $1162 <br />$786 2 $0 to $786 $787 to $982 $983 to $1179 $1180 to $1375 $1376 to $1571 $1572 <br />$991 3 $0 to $991 $992 to $1239 $1240 to $1486 $1487 to $1734 $1735 to $1981 $1982 <br />$1196 4 $0 to $1196 $1197 to $1495 $1496 to $1794 $1795 to $2093 $2094 to $2391 $2392 <br />$1401 5 $0 to $1401 $1402 to $1751 $1752 to $2101 $2102 to $2451 $2452 to $2801 $2802 <br />$1606 6 $0 to $1606 $1607 to $2007 $2008 to $2409 $2410 to $2810 $2811 to $3211 $3212 <br />$1811 7 $0 to $1811 $1812 to $2264 $2265 to $2716 $2717 to $3169 $3170 to $3621 $3622 <br />$2016 8 $0 to $2016 $2017 to $2520 $2521 to $3024 $3025 to $3528 $3529 to $4031 $4032 <br />$2221 9 $0 to $2221 $2222 to $2776 $2777 to $3331 $3332 to $3886 $3887 to $4441 $4442 <br />$2426 10 $0 to $2426 $2427 to $3032 $3033 to $3639 $3640 to $4245 $4246 to $4851 $4852 <br />$2631 11 $0 to $2631 $2632 to $3289 $3290 to $3946 $3947 to $4604 $4605 to $5261 $5262 <br />$2836 12 $0 to $2836 $2837 to $3545 $3546 to $4254 $4255 to $4963 $4964 to $5671 $5672 <br /> <br />INSTRUCTIONS: AFTER DETERMINING SLIDING SCALE PAY CATEGORY, FIND DOLLAR AMOUNT OF CHARGE ON APPROPRIATE SCHEDULE. <br />NOTE: NO CHARGES MAY BE ASSESSED IF PATIENT IS MEDICAID ELIGIBLE. IF YEARLY INCOME IS KNOWN, USE ANNUAL SCALE. <br /> ANNUALIZED MONTHLY INCOME FIGURES MAY NOT EQUAL THOSE ON ANNUAL SCALE DUE TO ROUNDING. <br />DIV. OF MCH SCHEDULE OF PATIENT (SELF-PAY OR PRIVATE PAY) CHARGES <br />5/14/93 WOMEN'S PREVENTIVE HEALTH SERVICES (FAMILY PLANNING) <br /> <br /> SERVICE <br />Complete Physical <br /> (Initial or Annual) <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 80% PAY FULL PAY <br /> <br /> $19.00 $38.oo $56.oo $75.oo $94.oo <br /> $ 8.oo $16.00 $23.00 $31.00 $39.00 <br /> $ 4.00 $ 9.00 $13.00 $18.00 $22.00 <br /> $ 8.oo $16.00 $24.oo $32.oo $4o.oo <br /> <br />$101.00 $2o2.oo $3o4.oo $4o5.oo $5o6.oo <br />$25.oo $ 5o.oo $ 75.oo $100.00 $125.00 <br />$121.00 $242.00 $364.00 $485.00 $606.00 <br />5.00 $ 10.00 $ 16.00 $ 21.00 $ 26.00 <br /> <br />~o <br />o <br /> <br /> o <br /> <br /> o <br /> <br /> ~ o <br /> <br /> o ~ <br /> <br /> <br />