509-662-6000
Sliding Fee Scale
What is a Sliding Fee Scale?
A sliding fee scale is a program offered by CVCH to make healthcare services more affordable for our patients. This program adjusts the cost of care based on a patient’s gross family income and number of household members, allowing those with lower incomes to pay reduced fees.
By using a sliding scale, CVCH ensures that essential healthcare services remain accessible to all members of the community, regardless of their financial situation. CVCH will not deny services based on a patient’s inability to pay, even if that means reducing or waiving costs.
The Sliding Fee Scale is revised annually based on the published Federal Poverty guidelines.
How to Apply for the Sliding Fee Discount Program
- Make an appointment with Member Services who will assist you in reviewing your insurance options.
- Complete the Sliding Fee application.
- Provide CVCH proof of your estimated current annual income:
- Tax return, proof of income foe the last 60 days, self-employment bookkeeping records, SSI, Unemployment benefits, recent tax return, or
- Letter of financial support (unhoused only)
- Proof of income is required every 6-12 months to continue to qualify for the Sliding Fee Discount Program. You are encouraged to complete a new sliding fee application if your household size or monthly income changes.
Need Help?
Our Member Services Specialists can guide you through the enrollment process of our in-clinic Slide Fee and Washington Apple Health.
Call (509) 662-6000 or email our Member Services team at [email protected]
today and ask to speak with an Enrollment Specialist to see if you qualify!
You will be required to present documentation to determine eligibility for the Sliding Fee Program. These documents include proof of income for the last 60 days (paycheck stub or letter from employer) or your most recent tax return. Click here to view the list of required documents in English or click here to view the list of required documents in Spanish. Please bring these documents with you when you meet with your Member Services representative.
Other Financial Resources
- Poverty Scale
- Sliding Fee Scale
- Medical Services
- Dental Services
- Behavioral Services
Poverty Scale
Percent of Poverty Based on Family Size and Family Income Per Year
| Family Size | PLAN A: < 101% | PLAN B: 101 - 133% | PLAN C: 134 - 167% | PLAN D: 168 - 200% | NOT ELIGIBLE: >200% |
|---|---|---|---|---|---|
| 1 | $0 to $15,650 | $15,651 to $20,815 | $20,816 to $26,136 | $26,137 to $31,300 | $31,301 |
| 2 | $0 to $26,650 | $21,151 to $28,130 | $28,131 to $35,321 | $35,322 to $42,300 | $42,301 |
| 3 | $0 to $21,150 | $26,651 to $35,445 | $35,446 to $44,506 | $44,507 to $53,300 | $53,301 |
| 4 | $0 to $32,150 | $32,151 to $42,460 | $42,761 to $53,691 | $53,692 to $64,300 | $64,301 |
| 5 | $0 to $37,650 | $37,651 to $50,075 | $50,076 to $62,876 | $62,877 to $75,300 | $75,301 |
| 6 | $0 to $43,150 | $43,151 to $57,390 | $57,391 to $72,061 | $72,062 to $86,300 | $86,301 |
| 7 | $0 to $48,650 | $48,651 to $64,705 | $64,706 to $81,246 | $81,247 to $97,300 | $97,301 |
| 8 | $0 to $54,150 | $54,151 to $72,020 | $72,021 to $90,431 | $90,432 to $108,300 | $108,301 |
| 9 | $0 to $59,650 | $59,651 to $79,335 | $79,336 to $99,616 | $99,617 to $119,300 | $119,301 |
| 10 | $0 to $65,150 | $65,151 to $86,650 | $86,651 to $108,801 | $108,802 to $130,300 | $130,301 |
| 11 | $0 to $70,650 | $70,651 to $93,965 | $93,966 to $117,986 | $117,987 to $141,300 | $141,301 |
| 12 | $0 to $76,150 | $76,151 to $101,280 | $101,281 to $127,171 | $127,172 to $152,300 | $152,301 |
Percent of Poverty Based on Family Size and Family Income Per Month
| Family Size | PLAN A: < 101% | PLAN B: 101 - 133% | PLAN C: 134 - 167% | PLAN D: 168 - 200% | NOT ELIGIBLE: >200% |
|---|---|---|---|---|---|
| 1 | $0 to $1,304 | $1,305 to $1,735 | $1,736 to $2,178 | $2,179 to $2,608 | >$2,608 |
| 2 | $0 to $1,763 | $1,764 to $2,344 | $2,345 to $2,943 | $2,944 to $3,525 | >$3,525 |
| 3 | $0 to $2,221 | $2,222 to $2,954 | $2,955 to $3,709 | $3,710 to $4,442 | >$4,442 |
| 4 | $0 to $2,679 | $2,680 to $3,563 | $3,564 to $4,474 | $4,475 to $5,358 | >$5,358 |
| 5 | $0 to $3,138 | $3,139 to $4,173 | $4,174 to $5,240 | $5,241 to $6,275 | >$6,275 |
| 6 | $0 to $3,596 | $3,597 to 4,782 | $4,783 to $6,005 | $6,006 to $7,192 | >$7,192 |
| 7 | $0 to $3,054 | $3,055 to $5,392 | $5,393 to $6,770 | $6,771 to $8,108 | >$8,108 |
| 8 | $0 to $4,513 | $4,514 to $6,002 | $6,003 to $7,536 | $7,537 to $9,025 | >$9,025 |
| 9 | $0 to $4,971 | $4,972 to $6,611 | $6,612 to $8,301 | $8,302 to $9,942 | >$9,942 |
| 10 | $0 to $5,429 | $5,430 to $7,221 | $7,222 to $9,067 | $9,068 to $10,858 | >$10,858 |
| 11 | $0 to $5,888 | $5,889 to $7,830 | $7,831 to $9,832 | $9,833 to $11,775 | >$11,775 |
| 12 | $0 to $6,346 | $6,347 to $8,440 | $8,441 to $10,598 | $10,599 to $12,692 | >$12,692 |
Sliding Fee Scale
Sliding Fee Scale 2025
| Service | Plan A | Plan B | Plan C | Plan D | Not Eligible |
|---|---|---|---|---|---|
| Medical* | $40 | 75% Slide | 50% Slide | 25% Slide | not applicable |
| Medical Tier 2 | $150 | 75% Slide | 50% Slide | 25% Slide | not applicable |
| Dental* | $65 | 75% Slide | 50% Slide | 25% Slide | not applicable |
| Dental Tier 2** | $300 | 75% Slide | 50% Slide | 25% Slide | not applicable |
| Behavioral | $15 | 75% Slide | 50% Slide | 25% Slide | not applicable |
| SUD | $15 | 75% Slide | 50% Slide | 25% Slide | not applicable |
| Diabetes and Nutrition | $15 | 75% Slide | 50% Slide | 25% Slide | not applicable |
| Outreach | $0 | $0 | $0 | $0 | not applicable |
| Laboratory | 100% Slide | 75% Slide | 50% Slide | 25% Slide | not applicable |
| Contraceptive Devices*** | Acquisition + $25 | Acquisition + $50 | Acquisition + $75 | Acquisition + $100 | not applicable |
| Vaccines Tier 3*** | $100 | $120 | $140 | $160 | not applicable |
| Pharmacy <30-day supply** | Acquisition + $5 | Acquisition + $6 | Acquisition + $7 | Acquisition + $8 | not applicable |
| Pharmacy>30-Day supply*** | Acquisition + $10 | Acquisition + $12 | Acquisition + $14 | Acquisition + $16 | not applicable |
Any sliding fee scale within tier B, C, or D will be at least the nominal charge listed in slide A plus a dollar.
If you have questions regarding these slides or the cost of services, please speak with any Member Services Representative for further information.
* Sliding Fee charges will not exceed the billed charge. Certain services may include an additional lab fee.
** Dental procedures may include a lab fee in addition to fee shown in the schedule above. You will be provided a cost estimate prior to scheduling these appointments.
*** Services where the purchasing cost of a prescription, equipment or item plus a flat fee will be charged.
Medical Services
Medical Services - Diabetes & Nutrition
| Service | Code | Slide A | Slide B | Slide C | Slide D | NO Slide |
|---|---|---|---|---|---|---|
| Program or Service | 97802 | $15 | $20 | $40 | $60 | $80 |
| Medical* | 97803 | $15 | $17 | $35 | $52 | $69 |
| Medical Tier 2 | G0108 | $15 | $23 | $46 | $69 | $92 |
Medical Services - Annual Preventative
| Service | Code | Slide A | Slide B | Slide C | Slide D | NO Slide |
|---|---|---|---|---|---|---|
| Established Patient Preventative Visit - Infant | 99391 | $40 | $49 | $97 | $146 | $194 |
| Established Patient Preventative Visit - Age 1-17 | 99392-99394 | $40 | $52 | $103 | $155 | $206 |
| Established Patient Preventative Visit - Age 18-65+ | 99395-99397 | $40 | $65 | $131 | $196 | $261 |
| New Patient Preventative - Infant | 99381-99382 | $40 | $47 | $93 | $140 | $186 |
| New Patient Preventative - Age 5-17 | 99383-99384 | $40 | $55 | $110 | $164 | $219 |
| New Patient Preventative - Age 18-65+ | 99385-99387 | $40 | $70 | $141 | $211 | $281 |
Medical Services - General
| Service | Code | Slide A | Slide B | Slide C | Slide D | NO Slide |
|---|---|---|---|---|---|---|
| Office Visit | 99211-99215 | $40 | $79 | $158 | $236 | $315 |
| New Patient Visit | 99201-99205 | $40 | $116 | $232 | $314 | $464 |
| New Patient Visit - Age 0-4 | 99381-99382 | $40 | $51 | $103 | $154 | $205 |
Medical Services - Medication Management with Psychiatric Nurse Practitioner
| Service | Code | Slide A | Slide B | Slide C | Slide D | NO Slide |
|---|---|---|---|---|---|---|
| Office/Outpatient Visit - Estimated 10-29 Minutes | 99212-99213 | $40 | $41 | $76 | $114 | $152 |
| Office/Outpatient Visit - Estimated 30-54 Minutes | 99214-99215 | $40 | $79 | $158 | $236 | $315 |
| Telehealth Visit - Estimated 10-29 Minutes | 98012-98014 | $40 | $52 | $104 | $156 | $208 |
Medica Medical Services - Contraceptive
| Service | Code | Slide A | Slide B | Slide C | Slide D | NO Slide |
|---|---|---|---|---|---|---|
| Insert Intrauterine Device | 58300 | $40 | $114 | $228 | $342 | $456 |
| Remove Intrauterine Device | 58301 | $40 | $69 | $138 | $206 | $275 |
| Mirena IUD | J7298 | $363 | $388 | $413 | $438 | $1,376 |
| Intrauterine Copper Copper Contraceptive (Paraguard) | J7300 | $320 | $345 | $370 | $395 | $1,364 |
| Nexplanon | J7307 | $546 | $571 | $596 | $621 | $1,364 |
| Skyla | J7301 | $554 | $579 | $604 | $629 | $1,133 |
| Kyleena | J7296 | $659 | $684 | $709 | $734 | $1,361 |
| Liletta | J7297 | $125 | $150 | $175 | $200 | $1,044 |
Dental Services
Dental Services Tiers
| Sliding Fee Discount Category | Tier 1 - Basic Dental Services (Dental Exams, Imaging, Basic Cleanings, Fluoride and Periodontal Maintenance) | Tier 2 - Restorative and Periodontal Services (Crown, Inlays and Onlays, Endodontics, Extractions, Occlusal Guards, Etc.) |
|---|---|---|
| A <101% | No Discount | No Discount |
| B 101-133% | 75% Slide | 75% Slide |
| C 134-167% | 50% Slide | 50% Slide |
| D 168-200% | 25% Slide | 25% Slide |
| >200% | No Discount | No Discount |
*Dental Procedures may include a lab fee in addition to the fee shown in the schedule. You will be provided a cost estimate prior to scheduling these appointments.
Basic Dental Services
| Service | Code | Slide A | Slide B | Slide C | Slide D | NO Slide |
|---|---|---|---|---|---|---|
| Periodic Oral Examination, X -Ray First Film, X-Ray Add Film, X-Ray Bitewings Four Film, Cleaning (Age 14+), Fluoride, Panoramic Film | 99391 | $40 | $49 | $97 | $146 | $194 |
| Comprehensive Oral Evaluation, Intraoral Periapical Film First, Intraoral Periapical - Each Additional, Bitewings - Four Films, Panoramic Film | 99392-99394 | $40 | $52 | $103 | $155 | $206 |
| Established Patient Preventative Visit - Age 18-65+ | 99395-99397 | $40 | $65 | $131 | $196 | $261 |
| New Patient Preventative - Infant | 99381-99382 | $40 | $47 | $93 | $140 | $186 |
| New Patient Preventative - Age 5-17 | 99383-99384 | $40 | $55 | $110 | $164 | $219 |
| New Patient Preventative - Age 18-65+ | 99385-99387 | $40 | $70 | $141 | $211 | $281 |
Tier 2 Dental Services
| Service | Code | Slide A | Slide B | Slide C | Slide D | Lab Fee (at cost) | Self Pay-No Slide* (Lab Fee Not Included) |
|---|---|---|---|---|---|---|---|
| Crown-porcelain/ceramic | D2740 | $300 | $367.25 | $734.50 | $1,101.75 | $215 | $1.469 |
| Crown-porcelain/high noble metal | D2750 | $300 | $360.50 | $721 | $1,081.50 | $215 | $1,442 |
| Crown-porcelain/noble metal | D2752 | $300 | $350 | $700 | $1,050 | $215 | $1,400 |
| Crown full cast noble metal | D2792 | $300 | $352.50 | $705 | $1,057.50 | $215 | $1,410 |
| RCT, Anterior | D3310 | $300 | $301 | $487.50 | $731.25 | $0 | $975 |
| RCT, Bicuspid | D3320 | $300 | $301 | $551 | $826.50 | $0 | $1,102 |
| RCT, Molar | D3330 | $300 | $334.75 | $669.50 | $1,004.25 | $0 | $1,339 |
| Retreat Previous Rcnl Therap-a | D3346 | $300 | $301 | $563 | $844.50 | $0 | $1,126 |
| Retreat Previous Rcnl Therap-b | D3347 | $300 | $319.25 | $638.50 | $957.75 | $0 | $1,277 |
| Retreat Previous Rcnl Therap-m | D3348 | $300 | $385 | $770 | $1,155 | $0 | $1,540 |
| Complete Denture Maxillary | D5110 | $300 | $563 | $1,126 | $1,689 | Market Price** | $2,279 |
| Complete Denture Mandibular | D5120 | $300 | $569.75 | $1,139.50 | $1,709.25 | Market Price** | $2,279 |
| Immediate denture maxillary | D5130 | $300 | $591.50 | $1,183 | $1,774.50 | Market Price** | $2,366 |
| Dentures immediate mandible | D5140 | $300 | $596.50 | $1,193 | $1,789.50 | Market Price** | $2,386 |
| Maxillary partial dent-resin B, mandibular partial dent-resin | D5211-D5212 | $300 | $445.75 | $891.50 | $1,337.25 | Market Price** | $1,783 |
| Pontic Cast High Noble Metal | D6210 | $300 | $356.50 | $713 | $1,069.50 | Market Price** | $1,426 |
| Pontic Cast Predom Base Metal | D6211 | $300 | $356.50 | $674 | $1,011 | $215 | $1,348 |
| Pontic Cast Predom Base Metal | D6212 | $300 | $349 | $698 | $1,047 | $215 | $1,396 |
| Pontic Titanium | D6214 | $300 | $359.50 | $718.50 | $1,077.75 | $215 | $1,437 |
| Pontic Porc Fused High Noble Metal | D6240 | $300 | $359.50 | $719 | $1,078.50 | $215 | $1,438 |
| Pontic Porc Fused Predom Base | D6241 | $300 | $340.25 | $680.50 | $1,020.75 | $215 | $1,361 |
| Pontic Porc Fused Noble Metal | D6242 | $300 | $347.25 | $694.50 | $1,041.75 | $215 | $1,389 |
| Pontic Porcelain/Ceramic | D6245 | $300 | $360.50 | $721 | $1,081.50 | $215 | $1,442 |
| FPD retainer crown porcelain | D6740 | $300 | $367.50 | $735 | $1,102.50 | $215 | $1,470 |
| Crown porc fused high noble metal | D6750 | $300 | $360.25 | $720.50 | $1,080.75 | $215 | $1,441 |
| Crown full cast high noble metal | D6790 | $300 | $36354.250.25 | $708.50 | $1,062.75 | Market Price* | $1,417 |
Behavioral Services
Behavioral Health Services - Individual
| Service | Code | Slide A | Slide B | Slide C | Slide D | NO Slide |
|---|---|---|---|---|---|---|
| Psychotherapy Diagnostic Evaluation | 90791 | $15 | $73 | $145 | $218 | $290 |
| Psychotherapy Diagnostic Evaluation With Medication Services | 90792 | $15 | $74 | $148 | $221 | $295 |
| Psychotherapy - 30-60 Minutes | 90832, 90834, 90837 | $15 | $50 | $99 | $149 | $198 |
Behavioral Health Services - Group
| Service | Code | Slide A | Slide B | Slide C | Slide D | Self Pay-No Slide* (Lab Fee Not Included) |
|---|---|---|---|---|---|---|
| Family Psychotherapy | 90846-90847 | $15 | $44 | $87 | $131 | $174 |
| Multiple Family Group Psychotherapy | 90849 | $15 | $28 | $55 | $83 | $110 |
| Group Psychotherapy | 90853 | $15 | $19 | $28 | $57 | $76 |
| Health Behavior Intervention - Individual Face to Face (Initial 30 Minutes) | 96158 | $15 | $41 | $82 | $122 | $163 |
| Health Behavior Assessment (Or Re-Assessment) | 96156 | $15 | $57 | $114 | $171 | $228 |
Behavioral Health Services - Testing
| Service | Code | Slide A | Slide B | Slide C | Slide D | Self Pay-No Slide* (Lab Fee Not Included) |
|---|---|---|---|---|---|---|
| Psychotherapy Testing - First Hour | 96130 | $15 | $54 | $109 | $163 | $217 |
| Psychotherapy Testing - Each Additional Hour | 96131 | $15 | $44 | $87 | $131 | $174 |
| Neuro Psychotherapy Testing - First Hour | 96132 | $15 | $68 | $136 | $203 | $271 |
| Neuro Psychotherapy Testing - Each Additional Hour | 96133 | $15 | $63 | $126 | $188 | $251 |
| Psychotherapy or Neuro Test Administration & Scoring - First 30 Minutes | 96136 | $15 | $27 | $55 | $82 | $109 |
| Psychotherapy or Neuro Test Administration & Scoring - Each Additional 30 Minutes | 96137 | $15 | $27 | $55 | $82 | $109 |
Behavioral Health Services - New Path (Substance Use Disorder)
| Service | Code | Slide A | Slide B | Slide C | Slide D | Self Pay-No Slide* (Lab Fee Not Included) |
|---|---|---|---|---|---|---|
| Alcohol and/or Drug Assessment (New Patient) | H0001 | $15 | $49 | $98 | $147 | $196 |
| Behavioral Health Counseling (Per 15 Minutes) | H0004 | $15 | $16 | $23 | $35 | $46 |
| 30 Minute Group Intervention Services - 2+ Individuals | 96164 | $15 | $16 | $16 | $22 | $29 |
| Adult Group (Face to Face) - Per 15 Minutes | 96165 | $15 | $16 | $16 | $16 | $17 |
*Actual prices may be less than maximum price, but will not exceed the maximum for the codes listed. The prices listed are for the visit itself, and does not include the cost of vaccinations, tests, or other procedures that may be preformed.