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Western Wyoming Family Planning Fee Schedule (Code0) 2007-2008 Title X rev. 03/08 |
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Initial Comprehensive Exam: Includes: medical history, ed./counsel weight,B.P., UA in indicated, HCT, breast exam, pelvic, pap smear, and Chlymidia (includes State Meds) Per protocol or client request. |
Donations Asked |
| ThinPrep (includes all above): | Donations Asked |
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Annual Comprehensive Exam: Includes same as initial exam. |
Donations Asked |
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ThinPrep (includes all above):
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Donations Asked |
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Limited Visit Exam: 15 min includes: Breast, etc. |
Donations Asked |
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30 min includes: Diaphragm Fitting, IUD insertion.
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Donations Asked |
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Brief Visit: Includes: infertility counseling, Sterilization counseling, other Contraceptive related counseling.
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Donations Asked |
| Pregnancy Test: | Donations Asked |
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Contraceptive Supplies: Condoms |
Donations Asked |
| Oral Contraceptives: | Donations Asked |
| Depo-provera: | Donations Asked |
| Diaphram: | Donations Asked |
| Foam: | Donations Asked |
| Gynol Gel: | Donations Asked |
| IUD: | Donations Asked |
| Nuva Ring: | Donations Asked |
| Ortho Evra Patch: | Donations Asked |
| ECP (includes Pregnancy Test): | Donations Asked |
| (along with exam or pill pick-up): | Donations Asked |
| (STD test included): | Donations Asked |
| NON-TITLE X FEES | |
| Repeat Paps: | $26 |
| Thin Preps: | $40 |
| Wet Mounts: | $10 |
| STD visits (symptomatic): | $75 |
| STD visits (asymptomatic): | $40 |
| HPV Test along with Initial Or Annual Add: | $58 |
| Males STD Visit: | $40 |
| HPV treatment: | $30 |
| STD contact visit: | $10 |
| UTI check only (includes Bactrim): | $25 |
| State HIV test: | $10 |
| Clotrimazole: | $8 |
| Blood Draw Fee: | $5 |
| Metro 4: | $3 |
| Metro 14: | $3 |
| Colposcope: | $300 |