Sliding Fee Scale
We understand that life can be hard and money can be tight. We want all that need our services to have access to them and we’re doing our part by offering sliding fee rates for those who apply.
| Total Fees | 60% of total charges | 70% of total charges | 80% of total charge | Full Charges |
| Federal Poverty Level (FPL) | ≥ 150% | 151-175% | 176-200% | ≤ 200% |
| Family Size 1 | $0- $18,735 | $18,736-$21,858 | $21,859-$24,980 | $24,981+ |
| 2 | $21,139-$25,365 | $25,366-$29,593 | $29,594-$33,820 | $33,821+ |
| 3 | $26,664-$31,995 | $31,996-$37,328 | $37,329-$42,660 | $42,661+ |
| 4 | $32,189-$38,625 | $38,626-$45,063 | $45,064-$51,500 | $51,501+ |
| 5 | $37,714-$45,255 | $45,256-$52,798 | $52,799-$60,340 | $60,341+ |
| 6 | $43,239-$51,885 | $51,886-$60,533 | $60,534-$69,180 | $69,181+ |
| 7 | $48,764-$58,515 | $58,516-$68,268 | $68,269-$78,020 | $78,021+ |
| 8 | $54,289-$65,145 | $65,146-$76,003 | $76,004-$86,860 | $86,861+ |
| 9 | $59,814-$71,775 | $71,776-$83,738 | $83,739-$95,700 | $95,701+ |
| 10 | $65,339-$78,405 | $78,406-$91,473 | $91,474-$104,540 | $104,541+ |
| 11 | $70,864-$85,035 | $85,036-$99,208 | $99,209-$113,380 | $113,381+ |
| 12 | $76,389-$91,665 | $91,666-$106,943 | $106,944-$122,220 | $122,221+ |
Clients will be required to provide proof of residency (lease or mortgage), the last year’s tax return or the previous three months of consecutive pay stubs and any additional household income to include social security, child support or other income sources.
This sliding fee scale applies to patients who are uninsured or underinsured. Insured patients are asked to pay their insurance co-pay, and their insurance is billed for services. Insured patients are asked to provide income information above for sliding fee scale eligibility. If there are any charges not covered by insurance, their eligible sliding fee scale discount is applied to their balance. Chasity accepts most insurances but does NOT accept Medicare or Medicaid.
For consideration of a sliding fee scale please submit the appropriate documents in the sections below. Incomplete submissions will NOT be considered. Expect a response in 48-72 business hours.