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Sliding Scale Fee

No One Will Be Denied Access To Services Due To Inability To Pay.

At Park DuValle Community Health Center, no one will be denied access to services due to inability to pay; and there is a discounted / sliding fee schedule available based on family size and income. Please contact us or inquire at our front desk.

Effective December 11, 2023, there will be some changes made to our sliding fee scale for self-pay patients. Please see the table below for those changes in fees.

ALL self-pay patients are required to provide proof of income to qualify for the sliding fee scale. Those documents must be returned within 30 days of your first self-pay visit. Without those documents patients will be billed at 100%.

 

Sliding Fee Class

Income as a percent of Federal Poverty Level (FPL)

Patient Responsibility

Medical

 

Patient Responsibility

Dental & Behavioral

 

 

 

 

Class A

100% of FPL and below

Nominal Fee $25

Nominal Fee $50

Class B

101 to 125% of FPL

Billed 20% of Remaining Balance

Billed 20% of Remaining Balance

Class C

126 to 150% of FPL

Billed 40% of Remaining Balance

Billed 40% of Remaining Balance

Class D

151 to 175% of FPL

Billed 60% of Remaining Balance

Billed 60% of Remaining Balance

Class E

176% to 200% of FPL

Billed 80% of Remaining Balance

Billed 80% of Remaining Balance

Class F

Above 200% of FPL

Billed 100% of Remaining Balance

Billed 100% of Remaining Balance

 

Family Size

Class A

Class B

Class C

Class D

Class E

Class F

1

$0 – $14,580

$14,581 – $18,225

$18,226 – $21,870

$21,871 – $25,515

$25,516 – $29,160

$29,161 – up

2

$0 – $19,720

$19,721 – $24,650

$24,651 – $29,580

$29,581 – $34,510

$34,551 – $39,440

$39,441 – up

3

$0 – $24,860

$24,861 – $31,075

$31,076 – $37,290

$37,291 – $43,505

$43,506 – $49,720

$49,721 – up

4

$0 – $30,000

$30,001 – $37,500

$37,501 – $45, 000

$45,001 – $52,500

$52,501 – $60,000

$60,001 – up

5

$0 – $35,140

$35,141 – $43,925

$43,926 – $52,710

$52,711 – $61,495

$61,496 – $70,280

$70,281 – up

6

$0 – $40,280

$40,281 – $50,350

$50,351 – $60,420

$60,421 – $70,490

$70,491 – $80,560

$80,561 – up

7

$0 – $45,420

$45,421 – $56,775

$56,776 – $68,130

$68,131 – $79,485

$79,486 – $90,840

$90,841 – up

8

$0 – $50,560

$50,561 – $63,200

$63,201 – $75,840

$75,841 – $88,480

$88,481 – $101, 120

$101,121 – up

Download

Sliding Fee Scale DOC
en_USEN

Wilson Providers

Physicians

Ambrosio Romeo

Boos-Edward Alice

Briones Fe

Dowe Jessica

Estes Jennifer Kelly

Hernandez Diaz Leandro

Support

Ambrosio Romeo

Boos-Edward Alice

Briones Fe

Dowe Jessica

Estes Jennifer Kelly

Hernandez Diaz Leandro

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