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.
2020 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- $12,760 | $12,761- $15,950 | $15,951- $19,140 | $19,141- $25,520 | $25,521+ |
| 2 | $0- $17,240 | $17,241- $21,550 | $21,551- $25,860 | $25,861- $34,480 | $34,481+ |
| 3 | $0- $21,720 | $21,721- $27,150 | $27,151- $32,580 | $32,581- $43,440 | $43,441+ |
| 4 | $0- $26,200 | $26,201- $32,750 | $32,751- $39,300 | $39,301- $52,400 | $52,401+ |
| 5 | $0- $30,680 | $30,681- $38,350 | $38,351- $46,020 | $46,021- $61,360 | $61,361+ |
| 6 | $0- $35,160 | $35,161- $43,950 | $43,951- $52,740 | $52,741- $70,320 | $70,321+ |
| 7 | $0- $39,640 | $39,641- $49,550 | $49,551- $59,460 | $59,461- $79,280 | $79,281+ |
| 8 | $0- $44,120 | $44,121- $55,150 | $55,151- $66,180 | $66,181- $88,240 | $88,241+ |
Nominal Fee-$10
| Level 1 $20 Charge
| Level 2 $30 Charge
| Level 3 $40 Charge
| NO Discount |
*Based on 2020 Federal Poverty Guidelines published in the Federal RegisterJanuary 17, 2020
For families/households with more than 8 persons add $4,480 for each additional person.
Discounted charge includes all services performed by the center during the visit.
2020 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- $1,063 | $1,064- $1,329 | $1,330- $1,595 | $1,596- $2,126 | $2,127 |
| 2 | $0- $1,437 | $1,438 $1,796 | $1,797- $2,156 | $2,157- $2,874 | $2,875 |
| 3 | $0- $1,810 | $1,811- $2,263 | $2,264- $2,715 | $2,716- $3,620 | $3,621 |
| 4 | $0- $2,183 | $2,184- $2,729 | $2,730- $3,275 | $3,276- $4,366 | $4,367 |
| 5 | $0- $2,557 | $2,558- $3,196 | $3,197- $3,836 | $3,837- $5,114 | $5,115 |
| 6 | $0- $2,930 | $2,931- $3,663 | $3,664- $4,395 | $4,396- $5,860 | $5,861 |
| 7 | $0- $3,303 | $3,304- $4,129 | $4,130- $4,955 | $4,956- $6,606 | $6,607 |
| 8 | $0- $3,677 | $3,678- $4,596 | $4,597- $5,516 | $5,517- $7,354 | $7,355 |
Nominal Fee-$10
| Level 1 $20 Charge
| Level 2 $30 Charge
| Level 3 $40 Charge
| NO Discount |
*Based on 2020 Federal Poverty Guidelines published in the Federal RegisterJanuary 17, 2020
For families/households with more than 8 persons add $373 for each additional person.
Discounted charge includes all services performed by the center during the visit.
Click HERE to submit a Sliding Scale Application.