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R£ COHMEii01: D FEE SCALE
<br /> FAMILY SIZE
<br /> j PERCENT 5 6
<br /> i
<br /> OF CHARGE $ 2 3 4
<br /> 1'5 o Monthly Rangd $. 511 - under 68 - under #15552 - under
<br /> 668 - under 825 • under S 482 - under. $ 1'5 ,
<br /> Annual Range S 6,132 - under # $,015 - under $ 9,400 - under $11,784 - under $13,
<br /> 28% Monthly Range $ 512 - $ 613 S .669 - $ 801 $ 826 - $ 990 $ 983 - $ 1,178 S 1:140 - $ 1,367 5 1,297 - S 1,555
<br /> i Annual Range $ 6,133 - $ 7,356 $ 8,017 - $ 9,612 # 9,901 - $11,880 $11,785 - $14;136 113,669 * ;16,404 $15,553 - $18,660
<br /> 40% Annual Range $ 7,357 - $ 8,380 $ 9$613--5$11,208 $11,881 - 513.860 $14,137 - $16,488 #16,405 - $19,140 18,661 - $21,868
<br /> s 60% Monthly Range $ 716 -.5 . 817 $ 935 - $ 1,067 5 1,156 - $ 1.320 $ 1,375 - $ 1.578 $ 1.596 - S 1,823 $ 1,815 - $ 2,873.
<br /> jj Annual Range E'8,581 - 9,804 $11,209 - $12,804 13,861 - $15,840 $16,489 - $18,840 $19,141 - $21,876 $21,769 • $24,876
<br /> SOS Monthly Range $ 818 - $ 919 $ 1,068 - $ 1,200 $ 1,321 - $ 1,485 $ 1,571 - S 1,766 $ 1,824 - $ 2,051 $ 2,074 - $ 2,332
<br /> i Annual Range # 9,685 #11,028 $12,809 - $14,4ob 515,841 - $17,820 $18,941 - $21,192 $21,877 - $24,612 $24,877 - $27,984
<br /> ' i 100% Monthly Range $ 920 - over $ 1,201 - over $ 1,486 - aver $ 1,767 - over $ 2,852 - aver S 2,333 - over
<br /> it $24,613 - over $27,985 - over
<br /> Annual Range $11,029 - over $14,401 - over $17,821 - over $21,1.93 - over
<br /> ' 4
<br /> PERCENT
<br /> SIZE
<br /> PERCE
<br /> OF CHARGE 1 g g l8 11 12
<br /> 15ao Monthly Range S 3,326 - under S 1,355 - under, 5 1,385 - under 5 1,414 - under S 1,444 - under $ 1,473 - under
<br /> Annual Range 1,327$$15,912 - under $16,260 - under $16,620 - under $16,968 - under $17,328- under $17,676 - under
<br /> } 28% AnnualyRangeRange $15,912 - $19,892- 516,261 - $19,512 $16,621 - $19,944 $16 969 - $20,364 #17,329 - $20,796 $17,677 - $21,216
<br /> 4D% Mdnthly Range $ 1,592 - 5 1,856 $ 1,627 - $ 1,897 S 1,663 - $ 1,939 $ 1,698 - S 1,980 $ 1,734 - $ 2:022 $ 1,769 - $ 2,063
<br /> Annual Range $79.593 - #22,272 $13,513 - $22,764 $19,945 - $23,268 $20,365 - $23,768 $28,197 - $24,264 $21,217 - $24,756
<br /> 60% Monthly Range $ 1,85] - $ 2,121 $ 1,898 - $ 2,168 5 1,940 - S 2,216 S 1,981 - $ 2,263 $ 2.023 - $ 2,311 S 2,864 - $ 2,358
<br /> Annual Range $22,273 - $25.452 $22,765 - $26,016 $23,269 - $26,592 $23,761 - $27,156 $24,265 - $27,732 $24,757 $28,296
<br /> 8O% Monthly Range $ 2:122 - S 2,386 $ 2,169 - $ 2,439 $ 2,217 - $ 2.493 $ 2,264 - S 2.546 $ 2,312 - $ 2,600 $ 2,359 - i 2,653
<br /> Annual Range $25.453 - $28,632 $26.817 -
<br /> $29,268 $26,593 - $29 916 $27,156 - $30,552 $27,733 - $31,200 $28,297 - $31,836
<br /> 108% Monthly $28,633 - over 529.269 - over $29.917 - over $30,553 - over $31.281 - aver $31.837 - aver
<br /> 1.. •Persons whose income falls below 50% of the median income (56,132) receive services at no charge.
<br /> 2. The dollar figures in the above sliding fee scale represent monthly and annual gross income.
<br /> 3. �amsily size refers to the total number of persons supported by or dependent an that income.
<br /> 4. Service charges for patients certified for Title XIX or 'title XX will be reimbursed upon submission a€ claims to the
<br /> Division of Health Services,
<br /> 5. Patients whose income falls below Title XX income eligibility, but are not certified through Title XX for reimbursement,
<br /> ' will be assessed a nominal fee (15%) of full charges, (Family Planning only)
<br /> 6. A waiver of all Family Planning fees is applied to teenagers.
<br /> N. C. Department of Human Resources
<br /> Division of Health Services
<br /> Family Planning Branch 113179
<br />
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