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 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.
Poverty Scale:
Percent of Poverty | < 101% | 101 - 133% | 134 - 167% | 168 - 200% | >200% | |||||
Family Size | Family Income Per Year | |||||||||
1 | $0 to $15,060 | $15,061 to $20,030 | $20,031 to $25,150 | $25,151 to $30,120 | $30,121 | |||||
2 | $0 to $20,440 | $20,441 to $27,185 | $27,186 to $34,135 | $34,136 to $40,880 | $40,881 | |||||
3 | $0 to $25,820 | $25,821 to $34,341 | $34,342 to $43,119 | $43,120 to $51,640 | $51,641 | |||||
4 | $0 to $31,200 | $31,201 to $41,496 | $41,497 to $52,104 | $52,105 to $62,400 | $62,401 | |||||
5 | $0 to $36,580 | $36,581 to $48,651 | $48,652 to $61,089 | $61,090 to $73,160 | $73,161 | |||||
6 | $0 to $41,960 | $41,961 to $55,807 | $55,808 to $70,073 | $70,074 to $83,920 | $83,921 | |||||
7 | $0 to $47,340 | $47,341 to $62,962 | $62,963 to $79,058 | $79,059 to $94,680 | $94,681 | |||||
8 | $0 to $52,720 | $52,721 to $70,118 | $70,119 to $88,042 | $88,043 to $105,440 | $105,441 | |||||
9 | $0 to $58,100 | $58,101 to $77,273 | $77,274 to $97,027 | $97,028 to $116,200 | $116,201 | |||||
10 | $0 to $63,480 | $63,481 to $84,428 | $84,429 to $106,012 | $106,013 to $126,960 | $126,961 | |||||
11 | $0 to $68,860 | $68,861 to $91,584 | $91,585 to $114,996 | $114,997 to $137,720 | $137,721 | |||||
12 | $0 to $74,240 | $74,241 to $98,739 | $98,740 to $123,981 | $123,982 to $148,480 | $148,481 | |||||
Family Size | Family Income Per Month | |||||||||
1 | $0 to $1,255 | $1,256 to $1,669 | $1,670 to $2,096 | $2,097 to $2,510 | >$2,510 | |||||
2 | $0 to $1,703 | $1,704 to $2,265 | $2,266 to $2,845 | $2,846 to $3,407 | >$3,407 | |||||
3 | $0 to $2,152 | $2,153 to $2,862 | $2,863 to $3,593 | $3,594 to $4,303 | >$4,303 | |||||
4 | $0 to $2,600 | $2,601 to $3,458 | $3,459 to $4,342 | $4,343 to $5,200 | >$5,200 | |||||
5 | $0 to $3,048 | $3,049 to $4,054 | $4,055 to $5,091 | $5,092 to $6,097 | >$6,097 | |||||
6 | $0 to $3,497 | $3,498 to 4,651 | $4,652 to $5,839 | $5,840 to $6,993 | >$6,993 | |||||
7 | $0 to $3,945 | $3,946 to $5,247 | $5,248 to $6,588 | $6,589 to $7,890 | >$7,890 | |||||
8 | $0 to $4,393 | $4,394 to $5,843 | $5,844 to $7,337 | $7,338 to $8,787 | >$8,787 | |||||
9 | $0 to $4,842 | $4,843 to $6,439 | $6,440 to $8,086 | $8,087 to $9,683 | >$9,683 | |||||
10 | $0 to $5,290 | $5,291 to $7,036 | $7,037 to $8,834 | $8,835 to $10,580 | >$10,580 | |||||
11 | $0 to $5,738 | $5,739 to $7,632 | $7,633 to $9,583 | $9,584 to $11,477 | >$11,477 | |||||
12 | $0 to $6,187 | $6,188 to $8,228 | $8,229 to $10,332 | $10,333 to $12,373 | >$12,373 | |||||
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:
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:
Dental Services - Adult Exam/Dual Hygiene Visit | ||||||
| Service | Code | Slide A | Slide B | Slide C | Slide D | No Slide |
| Periodic Oral Examination | D0120 | $40 | $90 | $150 | $180 | $69 |
| X-Ray First Film | D0220 | $40 | $90 | $150 | $180 | $39 |
| X-Ray Add Film | D0230 | $40 | $90 | $150 | $180 | $33 |
| X-Ray Bitewings Four Film | D0274 | $40 | $90 | $150 | $180 | $84 |
| Cleaning (Age 14+) | D1110 | $40 | $90 | $150 | $180 | $120 |
| Fluoride | D1206 | $40 | $90 | $150 | $180 | $58 |
| Panoramic Film | D0330 | $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 Evaluation | D0150 | $40 | $90 | $150 | $180 | $117 |
| Intraoral Periapical Film First | D0220 | $40 | $90 | $150 | $180 | $39 |
| Intraoral Periapical - Each Additional | D0230 | $40 | $90 | $150 | $180 | $33 |
| Bitewings - Four Films | D0274 | $40 | $90 | $150 | $180 | $84 |
| Panoramic Film | D0330 | $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% | $90 | 75% Slide |
C 134-167% | $150 | 50% Slide |
D 168-200% | $180 | 25% 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
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 | No Slide |
| 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 | No Slide |
| 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 | 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+ 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.