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812-421-7489
 

SLIDING FEE SCHEDULE FOR MEDICAL AND DENTAL SERVICES

For those that are homeless, uninsured, or insured (with a high deductible or have services that aren't covered by insurance) that have qualifying incomes.

 

Federal Poverty Guideline

For Households with more than 8 people, add $4,140 for each additional person.
 

Patients at 100% or below the Federal Poverty Guideline will pay a nominal fee of $20.

Patients over 100% but at or below 200% of the Federal Poverty Guideline will pay according to below chart.

 

2016 Co-Pay Amounts

Follow-up visit is for visit within 14 days for the same issue.

$ = Amount Per Visit / Follow-up Visit