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 | $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:
% 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 |
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