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