Partnership Community Health Center, Inc. (PCHC) uses a sliding fee schedule based on the federal poverty guidelines established by the U.S. government. PCHC cannot deny services based on a person’s inability to pay.
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2021 Monthly Income Ranges for Federal Poverty Level (FPL) Calculation |
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|---|---|---|---|---|
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Household Size |
100% and below FPL |
101 – 133% FPL |
134 – 166% FPL |
167-200% FPL |
|
1 |
0 – 1,073 |
1,074 – 1,427 |
1,428 – 1,781 |
1,782 – 2,146 |
|
2 |
0 – 1,452 |
1,453 – 1,931 |
1,932 – 2,410 |
2,411 – 2,904 |
|
3 |
0 – 1,830 |
1,831 – 2,434 |
2,435 – 3,038 |
3,039 – 3,660 |
|
4 |
0 – 2,208 |
2,209- 2,937 |
2,938 – 3,665 |
3,666 – 4,416 |
|
5 |
0 – 2,587 |
2,588 – 3,441 |
3,442 – 4,294 |
4,295 – 5,174 |
|
6 |
0 – 2,965 |
2,966 – 3,943 |
3,944 – 4,922 |
4,923 – 5,930 |
|
7 |
0 – 3,343 |
3,344 – 4,446 |
4,447 – 5,549 |
5,550 – 6,686 |
|
8 |
0 – 3,717 |
3,718 – 4,944 |
4,945 – 6,170 |
6,171- 7,434 |
| For each additional person add: | 0-378 | 379-503 | 504-627 | 628-756 |
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100% Discount assessed to all charges with NOMINAL FEE requested |
SLIDING FEES |
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Fee Tier (Circle One) |
NOMINAL FEE |
Sliding Fee Tier 1 |
Sliding Fee Tier 2 |
Sliding Fee Tier 3 |
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Flat Fee Exam |
$20 * No more than $20 will be requested for a single date of service |
$30.00 |
$50.00 |
$80.00 |
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Fee For Non-Exam Services |
30% |
40% |
50% |
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Charges and Calculated Sliding Fee for Non-Exam services will vary based on the procedure or additional services being performed. If you qualify for reduced cost services, Partnership Community Health Center (PCHC) will notify you prior to your appointment with an estimated cost. The estimated cost is subject to change based on services done at your appointment. Payment is due at the time of your appointment. |
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Each year existing patients (and new patients) need to bring in proof of income (check stubs), picture ID, and current income tax forms.