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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.

 

LOCATE YOUR HOUSEHOLD INCOME ON THE CHART BELOW,
THEN FIND YOUR CO-PAY BY

Federal Poverty Guideline

For Households with more than 8 people, add $4,180 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

 

ECHO Community Health Care, Inc. is a participating entity in the federal 340-B drug pricing program. Please be informed that you have the right to choose the pharmacist and pharmacy provider where your prescriptions are filled and to not be pressured or coerced into transferring your prescriptions to another pharmacy or mail-order service.