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Sliding Fee Scales

Notice to patients: Community Health Centers of the Rutland Region serves all patients regardless of income or insurance status. Discounts for essential services provided by CHCRR are offered on a sliding fee scale basis adjusted for family size and income. Front desk personnel can assist you in applying, or you may apply directly by calling the clinic and asking for the patient outreach coordinator.

Medical Sliding Fee Scale

25% Discount

If your income falls between

Family Size Federal
Poverty Level
1 $20,503—$24,120
2 $27,609—$32,480
3 $34,715—$40,840
4 $41,821—$49,200
5 $48,927—$57,560
6 $56,033—$65,920
7 $63,139—$74,280
8 $70,245—$82,640

Greater of $20 Nominal Fee
or 75% collected at time of service

50% Discount

If your income falls between

Family
Size
Federal
Poverty Level
1 $16,282—$20,502
2 $21,925—$27,608
3 $27,568—$34,714
4 $33,211—$41,820
5 $38,854—$48,926
6 $44,497—$56,032
7 $50,140—$63,138
8 $55,783—$70,244

Greater of $20 Nominal Fee
or 50% collected at time of service

75%Discount

If your income falls between

Family
Size
Federal
Poverty Level
1 $12,061—$16,281
2 $16,241—$21,924
3 $20,421—$27,567
4 $24,601—$33,210
5 $28,781—$38,853
6 $32,961—$44,496
7 $37,141—$50,139
8 $41,321—$55,782

Greater of $20 Nominal Fee
or 25% collected at time of service

100%Discount

If your income falls between

Family
Size
Federal
Poverty Level
1 $0—$12,060
2 $0—$16,240
3 $0—$20,420
4 $0—$24,600
5 $0—$28780
6 $0—$32,960
7 $0—$37,140
8 $0—$41,320

$20 Nominal Fee
to be collected at time of service

Add: $4,180 for each additional family member over 8. 

Dental Sliding Fee Scale

25% Discount

If your income falls between

Family Size Federal
Poverty Level
1 $20,503—$24,120
2 $27,609—$32,480
3 $34,715—$40,840
4 $41,821—$49,200
5 $48,927—$57,560
6 $56,033—$65,920
7 $63,139—$74,280
8 $70,245—$82,640

25% of rendered service fee. Lab fees additional cost to patient

50% Discount

If your income falls between

Family
Size
Federal
Poverty Level
1 $16,282—$20,502
2 $21,925—$27,608
3 $27,568—$34,714
4 $33,211—$41,820
5 $38,854—$48,926
6 $44,497—$56,032
7 $50,140—$63,138
8 $55,783—$70,244

50% of rendered service fee. Lab fees additional cost to patient

75%Discount

If your income falls between

Family
Size
Federal
Poverty Level
1 $12,061—$16,281
2 $16,241—$21,924
3 $20,421—$27,567
4 $24,601—$33,210
5 $28,781—$38,853
6 $32,961—$44,496
7 $37,141—$50,139
8 $41,321—$55,782

Greater of $25 nominal. Lab fees additional cost to patient.

100%Discount

If your income falls between

Family
Size
Federal
Poverty Level
1 $0—$12,060
2 $0—$16,240
3 $0—$20,420
4 $0—$24,600
5 $0—$28780
6 $0—$32,960
7 $0—$37,140
8 $0—$41,320

$25 Nominal Fee to be collected at time of service.  Lab fees additional cost to patient.

Add: $4,180 for each additional family member over 8. 

Applying for Sliding Fee

When you come for your appointment to apply for sliding fee scales, please bring the following information with you:

  • Birth Certificate
  • Driver’s license
    with your picture on it or another photo ID showing your current address
  • Proof of Residency
    (postmarked envelope, postcard or envelope, driver’s license issued within the last 6 months, utility bill, lease/rent receipt, property tax records)
  • Proof of income
    including documentation for all wages earned (pay stubs for 4 consecutive pay periods or your tax return from the previous year), social security, worker’s comp, veteran’s benefits, military pay, child support/alimony, income from rent and interest/dividends from bank accounts, pensions and annuities.

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