Northwest Health Service clinics are open to patients with and without insurance. We accept most insurance and will either file claims for you or help with the completion of claims when needed. Uninsured patients are asked to complete a discount program application prior to service. Costs will be determined based on household size and income. Find the discount program application here.
About the Discount Program Application
The Discount Program application will help determine the cost for service based on household size and income. Northwest Health Services fees are based on a discount program which includes medical, dental, behavioral health and pharmacy services and is made possible through grant funding.
Please click the link below to see the discount charts.
Medical & Behavioral Health
| < 100% of Poverty Level | 101-150% of Poverty Level | 151-200% of Poverty Level | > 201% | ||
|---|---|---|---|---|---|
| Adults: Copay $25 (Below 19 yr/Copay$0) |
Copay $35.00 | Copay $45.00 | Patient Pays 100% | ||
| Poverty Level | Family Size | Level A | Level B | Level C | Level D |
| 11,490 | 1 | 0 to 11,490 | 11,491 to 17,235 | 17,236 to 22,980 | Over 22,981 |
| 15,510 | 2 | 0 to 15,510 | 15,511 to 23,265 | 23,266 to 31,020 | Over 31,021 |
| 19,530 | 3 | 0 to 19,530 | 19,531 to 29,295 | 29,296 to 39,060 | Over 39,061 |
| 23,550 | 4 | 0 to 23,550 | 23,551 to 35,325 | 35,326 to 47,100 | Over 47,101 |
| 27,570 | 5 | 0 to 27,570 | 27,571 to 41,355 | 41,356 to 55,140 | Over 55,141 |
| 31,590 | 6 | 0 to 31,590 | 21,591 to 47,385 | 47,386 to 63,180 | Over 63,181 |
| 35,610 | 7 | 0 to 35,610 | 35,611 to 53,415 | 53,416 to 71,220 | Over 71,221 |
| 39,630 | 8* | 0 to 39,630 | 39,631 to 59,445 | 59,446 to 79,260 | Over 79,261 |
* For family units with more than 8 members, add $4,020 for each additional member
Discounted fees are contingent upon proof of income and cannot be authorized without such proof. Completed income tax returns are the preferred acceptable proof of income. Any variances from this policy must be approved by the discount program Specialist in advance.
Pharmacy
| < 100-200% of Poverty Level | > 201% of Poverty Level | ||
|---|---|---|---|
| Cost + $11.00 Dispensing Fee | Patient Pays 100% | ||
| POVERTY LEVEL | Family Size | Level A, B, C | Level D |
| 11,490 | 1 | 0 to 22,980 | Over 22,981 |
| 15,510 | 2 | 0 to 31,020 | Over 31,021 |
| 19,530 | 3 | 0 to 39,060 | Over 39,061 |
| 23,550 | 4 | 0 to 47,100 | Over 47,101 |
| 27,570 | 5 | 0 to 55,140 | Over 55,141 |
| 31,590 | 6 | 0 to 63,180 | Over 63,181 |
| 35,610 | 7 | 0 to 71,220 | Over 71,221 |
| 39,630 | 8* | 0 to 79,260 | Over 79,261 |
For family units with more than 8 members, add $4,020 for each additional member.
Discounted fees are contingent upon proof of income and cannot be authorized without such proof. Completed income tax returns are the preferred acceptable proof of income. Any variances from this policy must be approved by the discount program Specialist in advance.
Discount program PATIENTS PAY: Prescription Cost + $11 Dispensing Fee Only
Dental
| < 100% of Poverty Level | 101-150% of Poverty Level | 151-200% of Poverty Level | > 201% | ||
|---|---|---|---|---|---|
| Below 19 yr/Copay $0 | Patient Pays 100% | ||||
| POVERTY LEVEL | Family Size | Level A | Level B | Level C | Level D |
| 11,490 | 1 | 0 to 22,980 | Over 22,981 | ||
| 15,510 | 2 | 0 to 31,020 | Over 31,021 | ||
| 19,530 | 3 | 0 to 39,060 | Over 39,061 | ||
| 23,550 | 4 | 0 to 47,100 | Over 47,101 | ||
| 27,570 | 5 | 0 to 55,140 | Over 55,141 | ||
| 31,590 | 6 | 0 to 63,180 | Over 63,181 | ||
| 35,610 | 7 | 0 to 71,220 | Over 71,221 | ||
| 39,630 | 8* | 0 to 79,260 | Over 79,261 |
* For family units with more than 8 members, add $4,020 for each additional member.
RAISE Clinic patients are eligible to receive dental services up to $1,000 per year without copay. After reaching services that total $1,000 RAISE Clinic patients who choose to continue to receive dental services, will be expected to pay applicable copay at the time of service. Copay does not apply for HOME Unit patients who are 100% of poverty or below for dental services provided at HOME Unit.
Discounted fees are contingent upon proof of income and cannot be authorized without such proof. Completed income tax returns are the preferred acceptable proof of income. Any variances from this policy must be approved by the discount program Specialist in advance.
COPAY AMOUNTS FOR BASIC DENTAL SERVICES ARE AS FOLLOWS:
- Level A = $60
- Level B = $70
- Level C = $80
BASIC SERVICES INCLUDE:
- Diagnostic Exams X-rays Cleaning + Filling; Tooth Removal
- $40 Copay + Copay applies for each tooth treated
COPAY AMOUNTS FOR DENTURES:
- $700 - $900 each upper and lower denture
EMERGENCY DENTAL SERVICES:
- NHS patients with current Discount Program status:
- Emergency Diagnostic Exam (Includes X-ray) + Copay for each tooth.
- Copay $60, $70 or $80 + Extraction copay $60 per tooth.
Other dental services are also available. Your Dentist will discuss the cost of each procedure with you prior to services being provided.

Northwest Health Services provides care to children and adults in the Missouri counties. Services vary by location. Find the Northwest Health Services provider near you.
Our staff is ready to assist you and schedule your next appointment. Are you a new patient? We have all the necessary forms available online so you can complete them before you arrive allowing us to process your information right away.
Northwest Health Services has been serving communities in Missouri for over 25 years. We’re proud to be a non-profit, community-owned organization.