For clients without insurance coverage and those choosing confidential services, WUPHD offers Family planning and STD program on a sliding fee scale. Use your income and family size to determine contribution level.
| Family Size | Income range for 0% contribution | Income range for 25% contribution | Income range for 50% contribution | Income range for 75% contribution | Income limit for 100% contribution | ||||
| 1 | 0-- | 12,491 | 18,735 | 18,736 | 24,980 | 24,981 | 31,225 | 31,226 | 18,735 |
| 2 | 0-- | 16,910 | 16,911 | 25,365 | 25,366 | 33,820 | 33,821 | 42,275 | 42,276 |
| 3 | 0-- | 21,330 | 21,331 | 31,995 | 31,996 | 42,660 | 42,661 | 53,325 | 53,326 |
| 4 | 0-- | 25,750 | 25,751 | 38,625 | 38,626 | 51,500 | 51,501 | 64,375 | 64,376 |
| 5 | 0-- | 30,170 | 30,171 | 45,255 | 45,256 | 60,340 | 60,341 | 75,425 | 75,426 |
| 6 | 0-- | 34,590 | 34,591 | 51,885 | 51,886 | 69,180 | 69,181 | 86,475 | 86,476 |
| 7 | 0-- | 39,010 | 39,011 | 58,515 | 58,516 | 78,020 | 78,021 | 97,525 | 97,526 |
| 8 | 0-- | 43,430 | 43,431 | 65,145 | 65,146 | 86,860 | 86,861 | 108,575 | 108,576 |
| Each additional family member | $4,420 | $4,420 | $4,420 | $4,420 | $4,420 | ||||
| % to charge | 0%/Donation | 25% | 50% | 75% | 100% |
Once you’ve calculated your contribution level, the fee schedule below will help you calculate the cost of services at the health department.
| Service | Donation | 25% | 50% | 75% | Full Price/100% |
|---|---|---|---|---|---|
| Visit Types | |||||
| RN Visit (STD, Contraceptive, etc) | $0.00 | $7.50 | $15.00 | $22.50 | $30.00 |
| Diaphragm Fit Visit | $0.00 | $25.00 | $50.00 | $75.00 | $100.00 |
| Injection Visit | $0.00 | $7.50 | $15.00 | $22.50 | $30.00 |
| IUD Insertion or Removal | $0.00 | $17.50 | $35.00 | $52.50 | $70.00 |
| Medical Revisit | $0.00 | $15.00 | $30.00 | $45.00 | $60.00 |
| Annual Visit, Established patient | $0.00 | $48.75 | $97.50 | $146.25 | $195.00 |
| Preventative Visit New 12-17y | $0.00 | $51.25 | $102.50 | $153.75 | $205.00 |
| Preventative Visit New 18-39y | $0.00 | $51.25 | $102.50 | $153.75 | $205.00 |
| Preventative Visit New 40-64y | $0.00 | $60.00 | $120.00 | $180.00 | $240.00 |
| STD Visit with Nurse Practitioner | $0.00 | $25.00 | $50.00 | $75.00 | $100.00 |
| Supplies or Treatment Visit | NC | NC | NC | NC | NC |
| Lab Services | |||||
| Pap Test | NC | NC | NC | NC | NC |
| Pap + HPV Testing | $0.00 | $12.50 | $25.00 | $37.50 | $50.00 |
| Breast Exam | NC | NC | NC | NC | NC |
| Chlamydia/Gonorrhea Culture | $0.00 | $19.27 | $38.54 | $57.81 | $77.08 |
| Hemoglobin | $0.00 | $2.50 | $5.00 | $7.50 | $10.00 |
| Vaginal Smear | $0.00 | $2.50 | $5.00 | $7.50 | $10.00 |
| Urinalysis Dipstick | $0.00 | $2.50 | $5.00 | $7.50 | $10.00 |
| Pregnancy Test Urine | $0.00 | $3.00 | $6.00 | $9.00 | $12.00 |
| VDRL Serology | NC | NC | NC | NC | NC |
| HBV (Hep B) Test | NC | NC | NC | NC | NC |
| Hep C Test | NC | NC | NC | NC | NC |
| Venipuncture | $0.00 | $7.50 | $15.00 | $22.50 | $30.00 |
| Orasure/Alere HIV Test | NC | NC | NC | NC | NC |
| Herpes Simplex Virus PCR | $0.00 | $25.00 | $50.00 | $75.00 | $100.00 |
| Trichomonas Amp | $0.00 | $3.00 | $6.00 | $9.00 | $12.00 |
| Contraceptive Supplies | |||||
| Condoms, 1 doz. | NC | NC | NC | NC | NC |
| Diaphragm 1 unit | $0.00 | $15.00 | $30.00 | $45.00 | $60.00 |
| Depo Provera | $0.00 | $13.25 | $26.50 | $39.75 | $53.00 |
| Jelly, Cream or Foam | $0.00 | $2.50 | $5.00 | $7.50 | $10.00 |
| Oral Contraceptives | $0.00 | $4.00 | $8.00 | $12.00 | $16.00 |
| Nuvaring | $0.00 | $10.00 | $20.00 | $30.00 | $40.00 |
| Mirena | $0.00 | $86.25 | $172.50 | $258.75 | $345.00 |
| Paragard | $0.00 | $58.75 | $117.50 | $176.25 | $235.00 |
| Pharmaceutical Supplies | |||||
| Emergency Contraceptive (Plan B) | $0.00 | $6.25 | $12.50 | $18.75 | $25.00 |
| Fluconazole 150 mg #1 | $0.00 | $3.75 | $7.50 | $11.25 | $15.00 |
| Hep A Vaccine (if uninsured) | NC | NC | NC | NC | NC |
| Hep B Vaccine (if uninsured) | NC | NC | NC | NC | NC |
| Acyclovir 400 mg | $0.00 | $2.50 | $5.00 | $7.50 | $10.00 |
| Amoxicillin 500 mg | $0.00 | $3.75 | $7.50 | $11.25 | $15.00 |
| Bactrim DS | $0.00 | $3.75 | $7.50 | $11.25 | $15.00 |
| Rocephin Injection 250mg | NC | NC | NC | NC | NC |