Patient Discount Fee Calculator
Community Health Centers, Inc has a discounted fee schedule to lower the
cost of healthcare for those patients with incomes at or below 200
percent of the federal poverty line. Patients who apply
for the sliding fee discount program will need to provide proof of income and household family size.
If you qualify for our discounted fee schedule, you can use the form below to calculate the fees you will
be expected to pay for your care.
A different fee structure applies to x-rays, lab work, birth control and dental labs.
These fees are billed separately and you are responsible for paying them. Please contact your provider for
details.
A voucher for medicines is available at your clinic for a $5 fee per prescription.
Payment of co-pays and certain other fees are expected at time of service. Uninsured patients are
also expected to pay appropriate co-pays at time of service. CHC accepts cash, Visa/Master Card,
your personal check from a local bank, and various forms of insurance.
Note: This discount fee schedule is subject to change upon CHC Board of Governors
recommendations.
The discounted "Sliding Fees" are base on published federal poverty line schedules
{2011 — Vol. 76, No. 13, January 20, 2011, pp. 3637-3638 }.
If you have any questions about our sliding fee please call
(801) 412-6920.
