Sliding Fee Schedule

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 Included Included Included Included No Discount
Laboratory (In-House) Included Included Included Included No Discount
Laboratory (Sent Out) Included 90% OFF 85% OFF 80% OFF No Discount
Pharmacy At Cost At Cost + $1.00/Rx At Cost + $2.00/Rx At Cost + $3.00/Rx No Discount
Household income is:

% of poverty guideline:

Household: 		≤ A

≤100%

Slide A 		> B ≤ C

101%> x ≤125%

Slide B 		> C ≤ D

126%> x ≤150%

Slide C 		> D ≤ E

151%> x ≤200%

Slide D 		> E

≥201%

Slide E
1 15,060 per year
1,255 per month
290 per week 		18,825 per year
1,569 per month
363 per week 		22,590 per year
1,883 per month
435 per week 		30,120 per year
2,510 per month
580 per week 		33,885 per year
2,824 per month
653 per week
2 20,440 per year
1,703 per month
394 per week 		25,550 per year
2,130 per month
493 per week 		30,660 per year
2,555 per month
591 per week 		40,880 per year
3,407 per month
788 per week 		45,990 per year
3,833 per month
887 per week
3 25,820 per year
2,152 per month
497 per week 		32,275 per year
2,690 per month
622 per week 		38,730 per year
3,228 per month
746 per week 		51,640 per year
4,304 per month
994 per week 		58,095 per year
4,842 per month
1,119 per week
4 31,200 per year
2,600 per month
600 per week 		39,000 per year
3,250 per month
750 per week 		46,800 per year
3,900 per month
900 per week 		62,400 per year
5,200 per month
1,200 per week 		70,200 per year
5,850 per month
1,350 per week
5 36,580 per year
3,048 per month
704 per week 		45,725 per year
3,811 per month
880 per week 		54,870 per year
4,573 per month
1,056 per week 		73,160 per year
6,097 per month
1,408 per week 		79,065 per year
6,589 per month
1,521 per week
6 41,960 per year
3,497 per month
807 per week 		52,450 per year
4,371 per month
1,009 per week 		62,940 per year
5,245 per month
1,211 per week 		83,920 per year
6,994 per month
1,614 per week 		94,410 per year
7,868 per month
1,816 per week
7 47,340 per year
3,945 per month
911 per week 		59,175 per year
4,932 per month
1,139 per week 		71,010 per year
5,918 per month
1,367 per week 		94,680 per year
7,890 per month
1,822 per week 		106,515 per year
8,877 per month
2,050 per week
8 52,720 per year
4,393 per month
1,014 per week 		65,900 per year
5,492 per month
1,268 per week 		79,080 per year
6,590 per month
1,521 per week 		105,400 per year
8,787 per month
2,028 per week 		118,620 per year
9,885 per month
2,282 per week
For each additional person add: 5,140 per YEAR l 428 per MONTH l 99 per WEEK