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fw. ­4 <br /> 114 NORTH CAROLINA STATEWIDE FMfILY PLANNING PROGRMi <br /> PATIENT FEES (REVISED AS OF JULY 1, 1980)* <br /> Discount Level Initial or Annual Visit Medical with Pelvic Visit Medical without Pelvic Visit <br /> 150 <br /> $ 9.00 $ 3.00 $ 1.00 <br /> z0 <br /> $12.00 $ 4.00 $ 2.00 <br /> 40% $25,00 $ 9.00 $ 5.00 <br /> i 605a $37.00 $13.00 $ 7.00 <br /> 80% $50.00 $18".00 $10.00 <br /> 100.1 $62.00 $23,00 $12.00 <br /> i <br /> 1 <br /> *Revised fees are based- on recent Division of Health Services time/cost study- <br /> Negotiated third party reimbursement rates are established at $68.74, $25.30 and $14.55. ; <br /> Patient fee charges are rounded down to the nearest dollar. <br /> Visit reimbursement rates reflect local provider cost and do not include state level costs for processing <br /> of claims and laboratory services. <br /> rEf.9 <br /> 91.10 1 Lem 1,10111 er A.n i 9[efr flrd]1.1-M re1W<Vfar Ikdk.1 u(e hra[ H1,1r 91 5. <br /> kSl #E,OD #1.00 3 1.90 <br /> re-S e nJ 30x 5[1.00 4 5.90 i 5.99 <br /> JL€l/dws +9x 4x5.99 419.09 3 ;.aa <br /> L0i f14.00 ; 4.09 <br /> 003 MAO 119.99 11k.00 <br /> 10.1E #75.39 #34.00 517.70 <br />