Sliding Fee Discount Program (Bloomington 2022)

Sliding Fee Discount Program

Patients who qualify can save money on our services by taking advantage of our sliding fee scale. You may be eligible even if you have insurance. We strongly encourage you to complete the screening to see if you qualify for this cost-saving program. If you qualify, we will let you know what financial documents to bring to your appointment, where we will help you complete the application. Rest assured, the records we keep are secure and completely confidential! _ Learn more about the Sliding Fee Scale here: https://centerstonehealthservices.org/sliding-fee-scale/
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Instructions - Please Read!

Fill out the section below that matches the number of people in your household. Leave the other sections blank.
Single Person Household

Please select your annual household income level.
Annual household Income is:

Less than or equal to $13,590Less than or equal to $20,385Less than or equal to $23,782.50Less than or equal to $27,180More than $27,180
2 Member Household
Annual household income Is

Less than or equal to $18,310Less than or equal to $27,465Less than or equal to $32,042Less than or equal to $36,620More than $36,620
3 Member Household
Annual household income Is

Less than or equal to $23,030Less than or equal to $34,545Less than or equal to $40,302.50Less than or equal to $46,060More than $46,060
4 Member Household
Annual household income Is

Less than or equal to $27,750Less than or equal to $41,625Less than or equal to $48,562.50Less than or equal to $55,500More than $55,500
5 Member Household
Annual household income Is

Less than or equal to $32,470Less than or equal to $48,705Less than or equal to $56,822.50Less than or equal to $64,940More than $64,940
6 Member Household
Annual household income Is

Less than or equal to $37,190Less than or equal to $55,785Less than or equal to $65,082.50Less than or equal to $74,380More than $74,380
7 Member Household
Annual household income Is

Less than or equal to $41,910Less than or equal to $62,865Less than or equal to $73,342.50Less than or equal to $83,820More than $83,820
8 Member Household
Annual household income Is

Less than or equal to $46,630Less than or equal to $69,945Less than or equal to $81,602.50Less than or equal to $93,260More than $93,260
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Sliding Fee Discount Program

Instructions - Please Read!

Single Person Household

2 Member Household

3 Member Household

4 Member Household

5 Member Household

6 Member Household

7 Member Household

8 Member Household