Payments

Fairfax Medical Facilities, Inc. accepts Medicare, Medicaid, SoonerCare, and most types of health insurance. If you do not have health insurance, your fees for services are based on a sliding fee scale if you are deemed eligible. We want everyone that needs services to be able to receive them regardless of your ability to pay.

Sliding Fee Classification	A	B	C	D	E	F
Federal Poverty Level*	< = 100%	125%	150%	175%	200%	>200%
Patient Payment Responsibility	Nominal Fee	20% of Standard Charge	40% of Standard Charge	60% of Standard Charge	80% of Standard Charge	100% of Standard Charge
Family Size	Annual Income	Annual Income	Annual Income	Annual Income	Annual Income	Annual Income
1	0 - 15,960	15,960 - 19,950	19,950 - 23,940	23,940 - 27,930	27,930 - 31,920	31,920+
2	0 - 21,640	21,640 - 27,050	27,050 - 32,460	32,460 - 37,870	37,870 - 43,280	42,280+
3	0 - 27,320	27,320 - 34,150	34,150 - 40,980	40,980 - 47,810	47,810 - 54,640	54,640+
4	0 - 33,000	33,000 - 41,250	41,250 - 49,500	49,500 - 57,750	57,750 - 66,000	66,000+
5	0 - 38,680	38,680 - 48,350	48,350 - 58,020	58,020 - 67,690	67,690 - 77,360	77,360+
6	0 - 44,360	44,360 - 55,450	55,450 - 66,540	66,540 - 77,630	77,630 - 88,720	88,720+
7	0 - 50,040	50,040 - 62,550	62,550 - 75,060	75,060 - 85,570	85,570 - 100,080	100,080+
8	0 - 55,720	55,720 - 69,650	69,650 - 83,580	83,580 - 97,510	97,510 - 111,440	111,440+
FOR EACH PERSON	5,680
*BASED ON THE 2026 HHS POVERTY GUIDELINES (https://aspe.hhs.gov/poverty-guidelines)

Corredizo Clasificación de tarifas	A	B	C	D	E	F
Nivel federal de pobreza *	< = 100%	125%	150%	175%	200%	>200%
Responsabilidad de pago del paciente	Tarifa nominal	20% de carga estándar	40% de carga estándar	60% de carga estándar	80% de carga estándar	100% de carga estándar
Familia Talla	Ingresos anuales	Ingresos anuales	Ingresos anuales	Ingresos anuales	Ingresos anuales	Ingresos anuales
1	0 - 15,960	15,960 - 19,950	19,950 - 23,940	23,940 - 27,930	27,930 - 31,920	31,920+
2	0 - 21,640	21,640 - 27,050	27,050 - 32,460	32,460 - 37,870	37,870 - 43,280	42,280+
3	0 - 27,320	27,320 - 34,150	34,150 - 40,980	40,980 - 47,810	47,810 - 54,640	54,640+
4	0 - 33,000	33,000 - 41,250	41,250 - 49,500	49,500 - 57,750	57,750 - 66,000	66,000+
5	0 - 38,680	38,680 - 48,350	48,350 - 58,020	58,020 - 67,690	67,690 - 77,360	77,360+
6	0 - 44,360	44,360 - 55,450	55,450 - 66,540	66,540 - 77,630	77,630 - 88,720	88,720+
7	0 - 50,040	50,040 - 62,550	62,550 - 75,060	75,060 - 85,570	85,570 - 100,080	100,080+
8	0 - 55,720	55,720 - 69,650	69,650 - 83,580	83,580 - 97,510	97,510 - 111,440	111,440+
PARA CADA PERSONA	5,680
*BASADO EN LAS DIRECTRICES DE POBREZA DEL HHS 2026 (https://aspe.hhs.gov/poverty-guidelines)

How to Read This Scale

Step 1: Locate the row corresponding to the number of individuals in your family.

Step 2: Move to the right until you find the range containing your average annual income.

Step 3: Go to the top of that column. The percentage shown is the portion of the bill you will pay.

* You Must Provide Proof of Income by presenting at least one of the items listed below:

Tax Forms from the most recent year
Paycheck stubs for three months with year to date income provided. Current paycheck stub must have current address.
Fixed income statement (example: pension, social security or all eligible on all eligible bank statements showing deposits)
Signed notarized letter from, example: Minister, Law enforcement, City hall or Lawyer verifying financial status, housing situation, and how you cover expenses.
Student grant information
If you are self-employed, tax forms from current year and a profit/loss statement.

* You must provide proof of address by presenting at least one of the items listed below:

Required-Drivers license or state issued ID card w/current address
Utility bill

REMEMBER All family income is to be included. Income is the AMOUNT EARNED BEFORE TAXES ARE DEDUCTED.

2026 Sliding Fee Scale Application Download (English)

2026 Sliding Fee Scale Application Download (Spanish)