Sliding Fee Schedule
2023 FEDERAL POVERTY GUIDELINES & SLIDING SCALE
| Department | Slide A | Slide B | Slide C | Slide D | Slide E |
|---|---|---|---|---|---|
| Medical | $20.00 | $25.00 | $30.00 | $35.00 | No Discount |
| Physical Therapy | $10.00/visit | 90% OFF | 85% OFF | 80% OFF | No Discount |
| Audiology | $20.00 (includes eval. selection and fitting) | 90% OFF | 85% OFF | 80% OFF | No Discount |
| Imaging | $0.00 | 90% OFF | 85% OFF | 80% OFF | No Discount |
| Laboratory (In-House) | $0.00 | $0.00 | $0.00 | $0.00 | No Discount |
| Laboratory (Sent Out) | $0.00 | At Cost | At Cost | At Cost | No Discount |
| Pharmacy | At Cost + Fees | At Cost + Fees | At Cost + Fees | At Cost + Fees | At Cost + Fees |
| Household income is: | ≤ A | > B ≤ C | > C ≤ D | > D ≤ E | > E |
|---|---|---|---|---|---|
| % of poverty guideline: | ≤100% | 101%> x ≤125% | 126%> x ≤150% | 151%> x ≤200% | ≥201% |
| Household | Slide A | Slide B | Slide C | Slide D | Slide E |
| 1 | 14,580 per year 1,215 per month 281 per week | 18,225 per year 1,519 per month 352 per week | 21,870 per year 1,823 per month 422 per week | 29,160 per year 2,430 per month 562 per week | 32,805 per year 2,734 per month 633 per week |
| 2 | 19,720 per year 1,643 per month 380 per week | 24,650 per year 2,055 per month 475 per week | 29,580 per year 2,465 per month 570 per week | 39,440 per year 3,287 per month 760 per week | 44,370 per year 3,698 per month 855 per week |
| 3 | 24,860 per year 2,072 per month 479 per week | 31,075 per year 2,590 per month 599 per week | 37,290 per year 3,108 per month 719 per week | 49,720 per year 4,144 per month 958 per week | 55,935 per year 4,662 per month 1,078 per week |
| 4 | 30,000 per year 2,500 per month 577 per week | 37,500 per year 3,125 per month 722 per week | 45,000 per year 3,750 per month 866 per week | 60,000 per year 5,000 per month 1,154 per week | 67,500 per year 5,625 per month 1,299 per week |
| 5 | 35,140 per year 2,928 per month 676 per week | 43,925 per year 3,661 per month 845 per week | 52,710 per year 4,393 per month 1,014 per week | 70,280 per year 5,857 per month 1,352 per week | 79,065 per year 6,589 per month 1,521 per week |
| 6 | 40,280 per year 3,357 per month 775 per week | 50,350 per year 4,196 per month 969 per week | 60,420 per year 5,035 per month 1,163 per week | 80,560 per year 6,714 per month 1,550 per week | 90,630 per year 7,553 per month 1,744 per week |
| 7 | 45,420 per year 3,785 per month 874 per week | 56,775 per year 4,732 per month 1,093 per week | 68,130 per year 5,678 per month 1,311 per week | 90,840 per year 7,570 per month 1,748 per week | 102,195 per year 8,517 per month 1,967 per week |
| 8 | 50,560 per year 4,213 per month 973 per week | 63,200 per year 5,267 per month 1,217 per week | 75,840 per year 6,320 per month 1,460 per week | 101,120 per year 8,427 per month 1,946 per week | 113,760 per year 9,480 per month 2,190 per week |
For each additional person add: 5,140 per YEAR l 428 per MONTH l 99 per WEEK