Use the chart below to determine where you fall on the sliding scale based on your family size and monthly household income. In the left column, find the number of people that live in the household with you, including adults and children. Then move across the chart to find the
correct total monthly household income. This should include income earned by a spouse or partner with whom you live. Round to the nearest dollar. Note which group this puts you in and then move to the next chart below. Monthly Income Per Family Size Number of people in household Group A Group B Group C Group D Group E 1 $0 — $430 — $859 — $1,289 — $1,718+ 2 $0 — $581 — $1,162 — $1,742 — $2,323+ 3 $0 — $733 — $1,465 — $2,197 — $2,929+ 4 $0 — $834 — $1,767 — $2,651 — $3,534+ 5 $0 — $1,035 — $2,070 — $3,131 — $4,139+ 6 $0 — $1,187 — $2,373 — $3,559 — $4,745+ 7 $0 — $1,338 — $2,675 — $4,013 — $6,687+ 8 $0 — $1,489 — $2,978 — $4,466 — $5,955+ Now that you know which group you’re in, select the service from the left side of the chart and match the price to your group. This is a list of our most popular services and are
only for patients not using insurance or state-funded program to pay for services. Don’t see the service you’re looking for or have a question? Please call (714) 922-4100 in Orange County or (909) 890-5511 in San Bernardino County. Remember, no one will be turned away due to inability to pay. PPOSBC Bundled Services Cash Prices SERVICE Group A Group B Group C Group D Group E Medication Abortion (abortion pill) $0 $187 $280 $373 $467 In-center abortion 1st trimester $0 $203 $304 $405 $507 In-center abortion 2nd trimester $0 $309 $464 $617 $771 IUD insertion $0 $234 $351 $468 $585 IUD removal $0 $80 $120 $159 $199 IUD insertion/removal same day $0 $296 $444 $591 $739 Implant insertion $0 $334 $501 $668 $836 Implant removal $0 $74 $111 $148 $186 Implant insertion/removal same day $0 $390 $586 $781 $976 Depo shot (birth control shot) – 1 shot $0 $68 $102 $136 $171 Emergency Contraception- 1 pill $0 $58 $87 $115 $144 Gardasil (HPV vaccine)- price per shot, 3 total needed $0 $201 $301 $401 $501 Flu vaccine- 1 shot $0 $10 $15 $20 $25 STI testing with medication $0 $40 $61 $81 $101 Colposcopy/LEEP $0 $86 $129 $173 $216 Ectopic pregnancy (Early Pregnancy Loss) $0 $163 $245 $326 $408 Pregnancy Bridge- 1 visit $0 $163 $245 $326 $408 Well-person visit (annual exam) $0 $70 $105 $140 $176 Infection check $0 $70 $105 $140 $176 Vasectomy $0 $215 $323 $431 $539 Office visit (birth control, pregnancy test, STI test, counseling, follow-ups) $0 $54 $81 $108 $136 Drive-Thru visit (birth control, pregnancy test, STI test, counseling, follow-up) No labs included $0 $24 $36 $38 $60 Add-On Services SERVICE Group A Group B Group C Group D Group E Birth control pills (any) $26 $26 $26 $26 $26 Birth control patches (3) $121 $121 $121 $121 $121 Condom- Female or Male $0 $0 $0 $0 $0 Depo $35 $35 $35 $35 $35 Emergency Contraception $9 $9 $9 $9 $9 Gardasil (1 shot) $366 $366 $366 $366 $366 IUD $454 $454 $454 $454 $454 Nexplanon (birth control implant) $700 $700 $700 $700 $700 NuvaRing (Ring) $9 $9 $9 $9 $9 Effective Sept 1, 2020 to June 30, 2021. Does not include all services or all add-on prices. For more information, call (714)922-4100 or
(909) 890-5511.
$429
$858
$1,288
$1,717
$580
$1,161
$1,741
$2,322
$732
$1,464
$2,196
$2,928
$833
$1,766
$2,650
$3,533
$1,034
$2,069
$3,130
$4,138
$1,186
$2,372
$3,558
$4,744
$1,337
$2,674
$4,012
$5,349
$1,488
$2,977
$4,465
$5,954
* For family units with more than 8 members, add $757.00 for each additional member’s monthly income.
* These are added prices if you decide to include something in addition to the services you were scheduled for.
All fees are subject to change without written notice. Please call to verify fees.
Fees quoted are based on a discounted cash fee for cash patients not having insurance.
Costs include lab fees, but not medication.
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