Fee Schedule

Partnership Community Health Center, Inc. (PCHC) uses a sliding fee schedule based on the federal poverty guidelines established by the U.S. government.

Poverty Level
Family Size

1
100% and below

2
101% - 133%

3
134% - 166%

4
167% - 200%

1

0 - 1,005

1,006 - 1,336

1,337- 1,668

1,669- 2,010

2

0 - 1,353

1,354 - 1,799

1,800- 2,245

2,246 - 2,706

3

0 - 1,701

1,702 - 2,262

2,263 - 2,823

2,824 - 3,402

4

0 - 2,050

2,051 - 2,726

2,727- 3,403

3,404- 4,100

5

0 - 2,398

2,399 - 3,189

3,190 - 3,980

3,981 - 4,796

6

0 - 2,746

2,747- 3,652

3,653 - 4,558

4,559 - 5,492

7

0 - 3,095

3,096 - 4,116

4,117- 5,137

5,138 - 6,190

8

0 - 3,443

3,444 - 4,579

4,580 - 5,715

5,716 - 6,686

Minimum Provider Fee

$20.00

$30.00

$50.00

$80.00

Procedures

20%

30%

40%

50%

Lab Visit (no insurance)$10.00 Pregnancy test
$27.00 Depo
$20.00 INR
$10.00 Pregnancy test
$27.00 Depo
$20.00 INR
$10.00 Pregnancy test
$27.00 Depo
$20.00 INR
$10.00 Pregnancy test
$27.00 Depo
$20.00 INR

 

**For families with more than 8 persons, add $338.0 for each person to calculate the poverty ranges**

Each year existing patients (and new patients) need to bring in proof of income (check stubs), picture ID, and current income tax forms.

Check stubs = 1 month | Tax returns = 1 year | Proof of no income = 3 months
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