CHAS Health Sliding Fee Discount Program & Good Faith Estimates

The mission of CHAS Health is to provide quality care regardless of your ability to pay. CHAS Health offers a discount program to patients that can reduce the cost of your care. If your household income qualifies you may receive reduced fees based on your application and proof of income. Household size is the number of individuals inside or outside of the household, including the applicant, who are at least 50% dependent upon the family income being reported on the application.

How much you will pay will depend on your income. We offer discounts off of regular charges based on a person’s income and the number of people in their household. When you visit CHAS Health, our staff will help you determine which sliding fee discount category you belong to.

To Apply for the Sliding Fee Discount Program you must:

  1. Make an appointment with a Patient Resources Coordinator (PRC) who will assist you in reviewing your insurance options.
  2. Fill out the CHAS Health’s Sliding Fee Discount Program Application.
  3. Give CHAS Health proof of your estimated current annual income:
    • Pay stubs, recent tax return, unemployment statements, SSI letter, child support statements, letter from employer, L&I award letter, bank statement, or
    • Signed Self-Declaration of Income
  4. Proof of income is required every year to continue to qualify for the Sliding Fee Discount Program. You are encouraged to fill out a new sliding fee application if your household size changes, or your monthly income changes by at least $150 and the change is expected to continue for at least two months.

Sliding Fee Discount Category

Household SizeABCDE
1$0 - $13,590$13,590.01 - $18,754.20$18,754.21 - $23,782.50$23,782.51 - $27,180Above $27,180
2$0 - $18,310$18,310.01 - $25,267.80$25,267.81 - $32,042.50$32,042.51 - $36,620Above $36,620
3$0 - $23,030$23,030.01 - $31,781.40$31,781.41 - $40,302.50$40,302.51 - $46,060Above $46.060
4$0 - $27,750$27,750.01 - $38,295$38,295.01 - $48,562.50$48,562.51 - $55,500Above $55,500
5$0 - $32,470$32,470.01 - $44,808.60$44,808.61 - $56,822.50$56,822.51 - $64,940Above $64,940

Sliding Fee Discount Program - Medical Services

Sliding Fee Discount CategoryMedical ServicesMedical Services (Behavioral Health & Expanded Care Team*)Spokane Urgent CareFlu Immunization & Hepatitis A Vaccine
A$25$0$60100% Discount
B$35$3$70100% Discount
C$55$6$85100% Discount
D$65$9$110100% Discount
ENo Discount**No Discount**No Discount**No Discount**

* Behavioral health sliding fee applies to visits with Behavioral Health providers including substance abuse. Expanded Care Team scale includes: Clinical Pharmacists, Registered Dieticians, Registered Nurse, Chronic Care Management and Collaborative Care Management programs.

**No Discount - Contact CHAS Health for a Good Faith Estimate of charges. 509.444.8200

Elective Services (Not subject to sliding fee discount)

Service TypeCost
Circumcision$200
Vasectomy$805

For Sliding Fee E (full fee) - Prices of common medical services

ServiceCodePrice Maximum*
Office visit, new patient99202-99205$404
Office visit, established patient99212-99215$274
Preventive annual health exam (18+ years old)99385-99387, 99395-99397$267
Well-child exam (17 and younger, vaccinations not included)99381-99384, 99395-99397$212
Behavioral health visit90791-90792, 90832-90837$289
Clinical pharmacist, medication management99606-99607$50
Registered nurse, chronic care management99487-99491$128
Registered dietitian97802-97804$58
Retinal scan92250$114
IUD or Nexplanon insertion or removal (device billed through pharmacy)58300-58301, 11981-11983$518
OB global package (prenatal care, vaginal delivery, postpartum care)59400-59430$4,371

*Actual prices may be less than maximum price but will not exceed the maximum for the codes listed. The prices listed are for the visit itself, and does not include the cost of vaccinations, tests, or other procedures that may be performed.

CHAS Health will not refuse to treat you based on your ability to pay. Contact a CHAS Health Patient Resources Coordinator at 509.444.8200 to learn about resources available to you.

Time of Service Discount

CHAS Health expects payment at the time of service. For medical and urgent care services a date of service discount will be taken for payment at the time of service. If you are unable to pay for services at your time of appointment, you will be billed your full sliding fee amount. If you are interested in setting up a payment plan, or if you have any questions about your sliding fee discounts please feel free to contact the CHAS Health Billing Department at 509.444.7880.

Services Outside of CHAS Health

CHAS Health’s Sliding Fee Discount Program can only apply to medical, pharmacy, dental, and behavioral health services provided at CHAS Health, as well as services provided at Spokane Urgent Care. Services provided by outside specialists, outside labs, or radiology are not covered and Patient will be responsible for any and all charges.

Inland Imaging & Quest Labs Discount

Inland Imaging and Quest Labs offer the following discounts for patients that qualify for CHAS Health Sliding Fee Discount program when the services are ordered by a CHAS Health provider.

CHAS Health Sliding Fee CategoryABCDE
Discount %100%75%50%25%None

Dental Services

Sliding Fee Discount CategoryDental ServicesDental Services (Crowns, Inlays & Onlays)
A$35$35 + 50% of lab fee
BLesser of $75 per visit or 30% of charges30% of professional fee + 50% of lab fee
CLesser of $100 per visit or 40% of charges40% of professional fee + 75% of lab fee
DLesser of $150 per visit or 60% of charges60% of professional fee + 75% of lab fee
ENo DiscountNo Discount

Note: Dental fee will not be less than $36 for Sliding Fee B, C, or D.

Prices of Common Dental Services

ServiceCodesABCDE
Adult Dental ExamD0150, D0210$35$72.30$96.40$144.60$241
Periodic Oral Exam (POE)D0120, D0274, D0220, D0230 (x2)$35$64.80$86.40$129.60$216
Limited Dental Exam (DX)D0140, D0220, D0270$35$42.30$59.20$88.80$148
Emergency Tooth Extraction (XA)D0140, D0220, D7140$35$75$100$150$317
Basic Cleaning with FluorideD1110, D1206$35$42.90$57.20$85.80$143
Basic Cleaning without FluorideD1110$35$36$40$60$100
Deep Cleaning (Peridontal Scaling) with FluorideD4341, D1206$35$75$100$150$330
Deep Cleaning (Periodontal Scaling) without FluorideD4341$35$75$100$150$287

A personalized dental treatment plan with recommended services and costs will be provided to you after a dental exam.

Pharmacy Services

Sliding Fee Discount CategoryPharmacy (Cost of the medication + dispensing fee)Pharmacy Blood Glucose Test Strips (Cost of the equipment + dispensing fee)Pharmacy (Bicillin & IUD medication only)
ACost of the medication + $0$0$0
BCost of the medication + $3$0 + $3$0
CCost of the medication + $6$0 + $6$0
DCost of the medication + $9$0 + $9$0
E >200% to 400% FPLCost of the medication + $23Cost of the equipment + $23Cost
Full Fee (Over 400% FPL)No Discount (Usual and Customary Fee* + $23)No Discount (Usual and Customary Fee* + $23)No Discount (Usual and Customary Fee*)

*Usual and Customary fee is the average wholesale price paid at a retail pharmacy.

If you would like to receive a Good Faith Estimate customized for you, please call 509.444.8200 and ask to speak with a Patient Resources Coordinator for a Good Faith Estimate.

Important Notes:  This Good Faith Estimate applies to uninsured patients who qualify for a sliding fee discount in categories A-D, and is based on our understanding of your needs as of today. While caring for you, our providers may recommend additional services that are not listed here. Your actual charges may vary from this estimate. This estimate is not a contract and does not require you to get services from CHAS Health.

For uninsured patients in category E of the sliding fee scale above, the estimate above is limited to common services and a range of prices associated with those services. For an actual Good Faith Estimate, please contact CHAS Health at 509.444.8200 and request a Good Faith Estimate.

If the actual charges are more than $400 above this estimate, you can initiate a provider-patient dispute resolution process. You can learn how to start this process at by calling CHAS Billing at 509.444.7880. Starting a dispute resolution process will not impact the quality of health services you receive at CHAS Health.

Good Faith Estimates Downloads