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812-421-7489
 

SLIDING FEE SCHEDULE FOR MEDICAL AND DENTAL SERVICES

 

The Sliding Fee Scale is for those who do not have medical and/or dental insurance. It is based upon income and the number of dependents in the household. Those that are uninsured and homeless are seen for FREE.

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 $4,420 for each additional person.
 

Patients at 100% or below with an income in the chart below by the number of people in your household will receive the maximum discount and your visit charges will be the nominal fee of $21.

Patients with an income above 100% will receive a discount if allowed by income and number of people in your household. Please see Sliding C though Sliding F listed below. All others above 200% will be charged $100 up front and billed the remainder.

 

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.