Western UP Health Department

Leading The Community Toward Better Health

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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.

ServiceDonation25%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