Sliding Fee Scale

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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:

  1. Make an appointment with Member Services who will assist you in reviewing your insurance options. 
  2. Complete the Sliding Fee application.
  3. Provide CVCH proof of your estimated current annual income: 
    1. Tax return, proof of income foe the last 60 days, self-employment bookkeeping records, SSI, Unemployment benefits, recent tax return, or
    2. Letter of financial support (unhoused only)
  4. 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 enrollment@cvch.org

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:

Good Faith Estimate
Helping Hand Fund
Sliding Fee Required Documentation 2025.01.pdf137.63 KB
Sliding Fee Required Documentation Spanish 2025.01.pdf181.54 KB

 

Use the calculator below to find out which plan you qualify for in the Poverty Scale table.

 

 

Poverty Scale:

Percent of Poverty

PLAN A: < 101%

PLAN B:  101 - 133%

PLAN C: 134 - 167%

PLAN D: 168 - 200%

NOT ELIGIBLE: >200%

Family Size

Family Income Per Year 

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 $21,150

$21,151 to $28,130

$28,131 to $35,321

$35,322 to $42,300

$42,301

3

$0 to $26,650

$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

 

Family Size

Family Income Per Month 

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 2025

Percent of Federal Poverty Guideline

<101%

101-133%

134-167%

168-200%

>200%

Program or Service

A

B

C

D

 

Medical*

$40

75% Slide

50% Slide

25% Slide

not applicable

Medical Tier 2

$150

$180

$210

$240

not applicable

Dental*

$40

$90

$150

$180

not applicable

Dental Tier 2**

$250

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

* 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. 

****Any sliding fee scale within tier B, C, or D will at least the nominal charge listed in slide A plus one dollar.

Medical Services - Diabetes & Nutrition

Service

Code

Slide A

Slide B

Slide C

Slide D

No Slide

Initial Medical Nutrition, Individual

97802

$15

$20

$40

$60

$80

Subsequent Medical Nutrition, Individual

97803

$15

$17

$35

$52

$69

Diabetes Management Training

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

 

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

$1,430

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

 

Medical Services - Vaccinations

Service

Code

Slide A

Slide B

Slide C

Slide D

No Slide

PCV20

90677

$100

$120

$140

$160

$370

Varicella

90716

$100

$120

$140

$160

$242

Shingrix

90750

$100

$120

$140

$160

$279

SARSCV2 (Covid)

91320

$100

$120

$140

$160

$190

Dental Services - Adult Exam/Dual Hygiene Visit

Service

Code

Slide A

Slide B

Slide C

Slide D

No Slide

Periodic Oral ExaminationD0120$40$90$150$180$69
X-Ray First FilmD0220$40$90$150$180$39
X-Ray Add FilmD0230$40$90$150$180$33
X-Ray Bitewings Four FilmD0274$40$90$150$180$84
Cleaning (Age 14+)D1110$40$90$150$180$120
FluorideD1206$40$90$150$180$58
Panoramic FilmD0330$40$90$150$180$148
Total$40$90$150$180$551

 

Dental Services - New Patient Exam

Service

Code

Slide A

Slide B

Slide C

Slide D

No Slide

Comprehensive Oral EvaluationD0150$40$90$150$180$117
Intraoral Periapical Film FirstD0220$40$90$150$180$39
Intraoral Periapical - Each AdditionalD0230$40$90$150$180$33
Bitewings - Four FilmsD0274$40$90$150$180$84
Panoramic FilmD0330$40$90$150$180$148
Total$40$90$150$180$421

 

Dental Services

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%$40$250
B 101-133%$9075% Slide
C 134-167%$15050% Slide
D 168-200%$18025% Slide
>200%100% (Full Fee)100% Slide

*Dental Procedures may include a lab fee in addition to the fee shown in the schedule above. You will be provided a cost estimate prior to scheduling these appointments.

Behavioral Health Services - Individual

Service

Code

Slide A

Slide B

Slide C

Slide D

No Slide

Psychotherapy Diagnostic Evaluation90791$15$73$145$218$290
Psychotherapy Diagnostic Evaluation With Medication Services90792$15$74$148$221$295
Psychotherapy - 30-60 Minutes90832, 90834, 90837$15$50$99$149$198

 

Behavioral Health Services - Group

Service

Code

Slide A

Slide B

Slide C

Slide D

No Slide

Family Psychotherapy90846-90847$15$44$87$131$174
Multiple Family Group Psychotherapy90849$15$28$55$83$110
Group Psychotherapy90853$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

No Slide

Psychotherapy Testing - First Hour96130$15$54$109$163$217
Psychotherapy Testing - Each Additional Hour96131$15$44$87$131$174
Neuro Psychotherapy Testing - First Hour96132$15$68$136$203$271
Neuro Psychotherapy Testing - Each Additional Hour96133$15$63$126$188$251
Psychotherapy or Neuro Test Administration & Scoring - First 30 Minutes96136$15$27$55$82$109
Psychotherapy or Neuro Test Administration & Scoring - Each Additional 30 Minutes96137$15$27$55$82$109

 

Behavioral Health Services - New Path (Substance Use Disorder)

Service

Code

Slide A

Slide B

Slide C

Slide D

No Slide

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+ Individuals96164$15$16$16$22$29
Adult Group (Face to Face) - Per 15 Minutes96165$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.