CFMWellness staff is available to assist clients in determining if they are eligible for our Sliding Fee Options. Clients MUST show most recent proof of income for all family members/individuals living in your household; examples of accepted documents include:
- Previous year’s 1040 tax form
- One month of pay stubs
- 1 unemployment stub
- Food Stamp Award Letter
- Copy of Social Security or Disability Check
- Letter from an employer that states your salary or wages.
Discount levels for patients who qualify are shown below.
2021 Sliding Fee Schedule-Annual Income
| Fed. Poverty Guideline | At or Below 100% | 101% – 125% | 126% – 150% | 151% – 200% | Above 200% |
| Family Size | Nominal Fee ($10) | Level 1 Charge $20 | Level 2 Charge $30 | Level 3 Charge $40 | No Discount |
| 1 | $0- $12,880 | $12,881- $16,100 | $16,101- $19,320 | $19,321- $25,760 | $25,761+ |
| 2 | $0- $17,420 | $17,421- $21,775 | $21,776- $26,130 | $26,131- $34,840 | $34,841+ |
| 3 | $0- $21,960 | $21,961- $27,450 | $27,451- $32,940 | $32,941- $43,920 | $43,921+ |
| 4 | $0- $26,500 | $26,501- $33,125 | $33,126- $39,750 | $39,751- $53,000 | $53,001+ |
| 5 | $0- $31,040 | $31,041- $38,800 | $38,801- $46,560 | $46,561- $62,080 | $62,081+ |
| 6 | $0- $35,580 | $35,581- $44,475 | $44,476- $53,370 | $53,371- $71,160 | $71,161+ |
| 7 | $0- $40,120 | $40,121- $50,150 | $50,151- $60,180 | $60,181- $80,240 | $80,241+ |
| 8 | $0- $44,600 | $44,601- $55,750 | $55,751- $66,900 | $66,901- $89,200 | $89,201+ |
Nominal Fee-$10
| Level 1 $20 Charge
| Level 2 $30 Charge
| Level 3 $40 Charge
| NO Discount |
*Based on 2021 Federal Poverty Guidelines published in the Federal RegisterJanuary 13, 2021
For families/households with more than 8 persons add $4,540 for each additional person.
Discounted charge includes all services performed by the center during the visit (i.e. in-house labs, x-rays, injections, labs performed by Lab Corp and any non-face to face visits associated f/u instructions initiated during the face to face visit.)
2021 Sliding Fee Schedule-Monthly Income
| Fed. Poverty Guideline | At or Below 100% | 101% – 125% | 126% – 150% | 151% – 200% | Above 200% |
| Family Size | Nominal Fee ($10) | Level 1 Charge $20 | Level 2 Charge $30 | Level 3 Charge $40 | No Discount |
| 1 | $0- $1,073 | $1,074- $1,341 | $1,342- $1,610 | $1,611- $2,146 | $2,147 |
| 2 | $0- $1,452 | $1,453 $1,815 | $1,816- $2,178 | $2,179- $2,904 | $2,905 |
| 3 | $0- $1,830 | $1,831- $2,288 | $2,289- $2,745 | $2,746- $3,660 | $3,661 |
| 4 | $0- $2,208 | $2,209- $2,760 | $2,761- $3,312 | $3,313- $4,416 | $4,417 |
| 5 | $0- $2,587 | $2,588- $3,234 | $3,235- $3,881 | $3,882- $5,174 | $5,175 |
| 6 | $0- $2,965 | $2,966- $3,706 | $3,707- $4,448 | $4,449- $5,930 | $5,931 |
| 7 | $0- $3,343 | $3,344- $4,179 | $4,180- $5,015 | $5,016- $6,686 | $6,687 |
| 8 | $0- $3,717 | $3,718- $4,646 | $4,647- $5,576 | $5,577- $7,434 | $7,435 |
Nominal Fee-$10
| Level 1 $20 Charge
| Level 2 $30 Charge
| Level 3 $40 Charge
| NO Discount |
*Based on 2021 Federal Poverty Guidelines published in the Federal RegisterJanuary 13, 2021
For families/households with more than 8 persons add $378 for each additional person.
Click HERE to submit a Sliding Scale Application.