Cole County Health Department

POVERTY LEVEL

0 – 100%

FAMILY SIZE	ANNUAL INCOME	MONTHLY INCOME	WEEKLY INCOME
1	0 – 10,210	0 – 851	0 – 213
2	0 – 13,690	0 – 1,141	0 – 285
3	0 – 17,170	0 – 1,431	0 – 358
4	0 – 20,650	0 – 1,720	0 – 430
5	0 – 24,130	0 – 2,011	0 – 503
6	0 – 27,610	0 – 2,301	0 – 575
7	0 – 31,090	0 – 2,591	0 – 648
8	0 – 34,570	0 – 2,881	0 – 720

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101% - 200%

FAMILY SIZE	ANNUAL INCOME	MONTHLY INCOME	WEEKLY INCOME
1	10,211 – 20,420	852– 1,702	214 – 426
2	13,691 – 27,380	1,142 – 2,282	286 – 571
3	17,171 – 34,340	1,432 – 2,862	359 – 716
4	20,651 – 41,300	1,721 – 3,442	431 – 861
5	24,131 – 48,260	2,012 – 4,022	504 – 1006
6	27,611 – 55,220	2,302 – 4,602	576 – 1,151
7	31,091 – 62,180	2,592 – 5,033	649 – 1,258
8	34,571 – 69,140	2,882 – 5,762	721 – 1,441

 

If above 200% client pays full price (C) ************************************************************************************

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CHART D - FAMILY PLANNING/STD SLIDING SCALE FEES

	A	B	C	D
	<100%	101%-200%	>200%	OOC
INITIAL EXAM	$25.00	$38.00	$50.00	$85.00
ANNUAL EXAM	$20.00	$30.00	$38.00	$75.00
PROBLEM FP	$10.00	$15.00	$20.00	$25.00
STD	$ 0.00	$10.00	$10.00	$10.00
DEPO SHOT	$30.00	$30.00	$30.00	$30.00
PILLS/CYCLE	$20.00	$20.00	$20.00	$20.00
ORTHO EVRA PATCH	$15.00	$15.00	$15.00	$15.00
SEASONALE	$65.00	$65.00	$65.00	$65.00

 

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